PORTAL Forms - Request Letter of Support

Thank you for your interest in the Kaiser Permanente & Strategic Partners Patient Outcomes Research to Advance Learning (PORTAL) Clinical Data Research Network (CDRN). Your brief description of the research concept or project will help us determine whether we can offer you a letter of support.


Please provide the following information so we can follow up on your inquiry. Please be prepared to enter all information at one time, including the attachment of a modifiable draft letter of support, as your work will not be saved if you exit before completing.

ADMINISTRATIVE ITEMS To whom the letter should be addressed

Title

First Name

Last Name

Job Title

Institution and Department

Email Address

Phone Number

Who is completing this form?

First Name
Last Name
Email Address

PORTAL AFFILIATION

Indicate your affiliation


Are there researchers at other PORTAL sites involved in this research concept or project?



Describe how PORTAL investigators may be expected to support you

What is the Letter of Support due date?

RESEARCH OBJECTIVE

Please describe your specific aims, study population, and methods. You may attach an abstract or describe below.

To attach an abstract:
Step 1.   Click the Browse File button to locate the file you want to attach.
Step 2.   Click the Save button to attach the file to your application.

Abstract attached


Describe below:


PROJECT STATUS

Federal Support for your project (mark all that apply)






For-Profit Support for your project
Does this study involve the support or collaboration of a for-profit entity?



DRAFT LETTER OF SUPPORT Please attach a draft Letter of Support that can be modified.

To attach a draft letter:
Step 1.   Click the Browse File button to locate the file you want to attach.
Step 2.   Click the Save button to attach the file to your application.

Letter attached





9. Additional Comments (Optional):