CALGARY LABORATORY SERVICES
LABORATORY
SERVICES
APPLICATIONCALGARY
FOR INTERNALLY
SUPPORTED
RESEARCH
APPLICATION FOR INTERNALLY SUPPORTED RESEARCH
Please complete this form for NEW STUDY APPLICATIONS ONLY. For an existing study that requires an
amendment/modification, please complete CLS form RE7160 CLS Research Project Update.
Applying for resident training fund support? Yes
No
(If Yes, indicate RTC funding on budget page)
If Yes, PI to work with AP Research contact to calculate budget, etc.
Name of Principal Investigator:
Clinical Section:
Resident Project? Yes
Title of Project:
Co-Investigator(s):
Application Date:
No
Phone:
Fax:
Email:
Project Start Date:
Project End Date:
Ethics Approval Required?
Yes
(Please include Residents)
No
Refer to http://www.ucalgary.ca/research/compliance/chreb/ for ethics
review requirements
Research Site:
Data Search Required?
Does the study have Ethics Approval? Yes
No
Yes
No
(If Yes, please complete & attach RFD Form #OP7076)
If Yes, state current valid Ethics ID:
APRL Services Required?
(Please attach copy of the Valid Ethics Approval)
(If Yes, please complete & attach APRL Attachment.
Include APRL tests, service costs, and data search costs
in project cost summary)
Yes
No
1. Objectives of the Study:
2. Rationale and Relevance:
3. Outline of Methods:
CLS INTERNAL RESEARCH PROJECT COST SUMMARY
Title of Project:
PI Name:
Cost Summary Prepared by:
Item:
Human Resources
Date:
AMOUNT (CAD $)
# of FTE x Hours x salary
Subtotal
Services / Procedures (# of Procedures x Cost)
(Consult Clinical Section Research Contact for quote)
RE7118
20150120
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Subtotal
Request for Data
(Contact Research Office for Quote)
Subtotal
Slide/Block Retrieval Costs
(Contact AP Research Contact for Quote)
Subtotal
Supplies and Equipment
(Consult Clinical Section Research Contact for quote)
Subtotal
Other Research Related Costs
APRL Services (from APRL Attachment)
Subtotal
TOTAL COST
FOR RESEARCH OPERATIONS USE ONLY
(Check √ applicable boxes)
FORMS ATTACHED:
Resident Training Funding Support
Ethics copy
APPROVAL GRANTED?
Yes
CLS INTERNAL FUNDING
APRL Request Form
No
RFD Request Form
If Yes, insert CLS Study Code (RS Number):
RESIDENT PROJECT
QA/ METHOD DEVELOPMENT
Research Contact Name
Date
Clinical Section Chief (Name)
Date
Clinical Section Manager
Date
CLS Research Committee (Name)
Date
RE7118
20150120
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