CTSC - Applications | SUNY Downstate Health Sciences University

Instructions for Submitting a CTSC Application

Faculty with active, approved IRB protocols may apply for CTSC membership by completing the Application Form below. Note that if you have more than one active IRB protocol, you must submit separate applications for each IRB protocol.

In addition to specifying the PI or co-I named on the IRB protocol, where indicated, you must also indicate the names and roles of key personnel involved in the study (e.g. co-PI, Nurse, Study Coordinator, Nurse Practitioner, Other). SUNY Downstate ID cards of the PI/co-I and key personnel will be programmed to enable swipe card access to the Center during non-business hours. Approved applications grant access to the CTSC for up to six month terms depending on the expiration date of the IRB protocol. CTSC access is renewable by certifying that the IRB protocol on the original application continues to be active.

Please don't fill out this input box.

Please select one of the following options:*

New CTSC member: Submitting application and IRB protocol

Current CTSC member: Adding or updating an IRB protocol

IRB Protocol NumberIndicate only ONE protocol per application. If you have more than one protocol and would like to use the CTSC as a resource for other IRB-approved studies, you must submit separate CTSC applications. All protocols must be active at the time of submission of a CTSC application.

IRB Protocol TitleIndicate the title that best summarizes your IRB-approved study

IRB Protocol Expiration DateDo not submit applications in which IRB approval is pending.

IRB Protocol AbstractPlease cut and paste abstract for the IRB protocol referenced above

Is the approved IRB study funded

Yes

If you checked yes above, please indicate funding source

Federal

Private Foundation

Industry Sponsor

Departmental Funds

Other

Is this a clinical trial

Yes

If yes, please indicate the clinicaltrials.gov website (URL):

CITI Training Date

PI or co-I named on the IRB protocol indicated above:

Full Name

Academic Title

Department

Work Phone

Work fax

Pager (if available)

E-Mail

Building

Floor

Room #

Personnel & Roles

What is the role of the person named above?

Principal Investigator

Co-Investigator

(MUST be PI or co-I)

Staff Names & RolesIn the box, please provide the names and roles (e.g. John Smith, Study Coordinator) of all key personnel named on the IRB protocol who will need access to the CTSC once this application is approved. Examples include Study Coordinator, Nurse Practitioner, etc. Note: all are required to have CITI training.

Contact Person & Phone NumberIn the box, please identify ONE person named in the previous question who should be listed as a Contact Person whenever your name appears as the Research Investigator on the scheduling calendar. If you prefer to be named as the Contact Person, simply add your name to the box below Be sure to include the Contact Person's phone number at Downstate.

What items will you require?

Subject exam table

OB/Gyn exam table

Alter-gravity treadmill

Scale (to measure subjects' weight)

Subject group meeting room (e.g. to conduct IRB-approved focus groups

Phlebotomy service

Core Laboratory (centrifuge, microscopes, water bath, etc.)

Other

Please indicate CTSC facility resources and services needed by checking all that apply in the list. Note that all subject rooms have a desk and three chairs. If something you need is not listed, please indicate that in the Other text box below. We may be able to help locate items that you will need.

Average length of time to be spent with each subject (or group of subjects if working with more than one subject at a time)?

What procedures will be performed on subjects participating in your study (e.g. interviews, physical exams, blood and/or urine collection, infusions,etc.)?

How many subjects do you anticipate enrolling in your study over the next six months (if this is a multi-site study, please answer be estimating subject number at Downstate only)?

Will you need to store biospecimens in the CTSC freezer (e.g. blood, urine) obtained from subjects (note that we allow storage of specimens in our -20 freezer for up to 24 hours)?

Yes

Do you anticipate needing access to the CTSC after regular business hours? (later than 5:00 PM)

Yes

Not Sure

Scheduling & Access

Once your application to use CTSC space has been approved, we will direct you to an on-line application where you can request access.

Questions? Contact Dr. Richard Coico, CTSC Director.