Research Study Proposal Form

Your research project begins with the submission of this Proposal, a list of pertinent literature citations, and, if funding is required, a detailed budget listing all expenses and proposed funding sources. Studies involving in vitro, animal, biomechanical, or clinical research utilize this process. If you have any questions, please call Joan Wilborn (901-271-0018).

(1) Complete every item in this Proposal. (2) All other supporting documents (up to and including a complete study protocol) must be submitted via email to aruch@inmotionmemphis.org. To obtain final approval, your InMotion Research Study Proposal should be presented at the next Research Committee Meeting.

To submit your proposal, please complete the following form or download the editable version which can be submitted via e-mail. Fields marked with * are required.

First Name
Last Name
Institutional Affiliation
Phone Number
Email
Study Title
Principle Investigator
Resident
Other Investigators
Potential Journal/Meeting Presentation
Type of Study (Check all that apply)	Clinical Retrospective Clinical Prospective Clinical X-Rays Necessary Randomized Invitro Animal Biomechanical
Budget Total
Purpose of the study (clearly state your hypothesis):
Study motivation (please include a description of relevant background research/current studies)
Identify any relevant inclusion/exclusion criteria (eg. age range, type of fracture, etc.)
Estimate the number of subjects needed for enrollment in the study
Estimate the time required to complete the data collection phase of the study
Start Date
End Date
List any methods/procedures required for completion of the study (tests, questionnaires, etc.)
If animals will be used, please indicate your plans for IACUC submission, housing, veterinarian...

Please answer the simple math question below to submit the form.

2 + 2 =