Carilion Clinic Research Application Form

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The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

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Required format:

FieoEI67gxoS64ZXf7zhpcHoLY2iKMqk8BXr68A6HHnNAvmvX9rydA67r9TpJoNI6isszSEvGgZxqP3iNuZcxraX2jjR4YQvH6JiV3eeWZtR9ZG6CoGhdiamv

Please complete and receive the department approval prior to IRB PRISM application.

For Department of Medicine applicants, please do not use this link. Instead, go to https://redcap.link/DOM_Research_Intake to complete and receive department approval. If you have any questions, please contact DoMResearch@carilionclinic.org.

For All Other Departments applicants or External Collaborators, please continue with this form. If you have any questions, please contact research@carilionclinic.org.

If you need advice regarding Epic data extracts, biostatistics support, data management (REDCap), Epic research builds, Epic research access, or feasibility volume to complete this application, please contact HART@carilionclinic.org.

Visit https://redcap.link/MyProjectPath for more information about research processes, resources and requirements at Carilion.

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