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Questionnaire regarding potentially becoming a D43 Participating Institute
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1.
Contact Information
(Required.)
Name
*
Institution
*
City/Town
State/Province
Country
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Email Address
*
*
2.
Does your institution have an ethics board or institutional review board (IRB) that oversees research protocols?
(Required.)
Yes
No
Don’t know
3.
Does your institution have active cancer research projects and researchers?
Yes
No
Don’t know
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4.
If yes, what areas of research are being undertaken at your institution? (Check all the apply)
(Required.)
Laboratory science (e.g., genetics, biology)
Population sciences (e.g., epidemiology, biostatistics, data science)
Psycho-oncology, behavioral science
Implementation and dissemination science
Clinical research (e.g., palliative care, clinical trials, therapeutic studies)
Other (please specify)
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5.
Are any of the following disease areas the subject of active research at your center?
(Required.)
Laboratory science (e.g., genetics, biology)
Population sciences (e.g., epidemiology, biostatistics, data science)
Psycho-oncology, behavioral science
Implementation and dissemination science
Clinical research (e.g., palliative care, clinical trials, therapeutic studies)
Other (please specify)
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6.
Does your institution or an affiliated institution offer advanced degrees in cancer-related disciplines (Masters, PhD, or similar)? For example, a hospital affiliated with a university
(Required.)
Yes
No
Don’t know
*
7.
Does your institution have a fiscal oversight office or unit that is capable of processing research grant submissions and managing grant funding when received?
(Required.)
Yes
No
Don’t know
*
8.
Has your institution received grant funding from outside funders?
(Required.)
Yes
No
Don't know
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9.
If yes, what funding sources have been previously held grants at your institution?
(Required.)
US National Institutes of Health
Cancer Research UK
American Cancer Society
Foundations (e.g., Susan G Komen, Prostate Cancer Foundation, others)
US Department of Defense
Other (please specify)
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10.
Is your institution registered in the US grant system (i.e., does your institution have a DUNS number, FWA, etc)
(Required.)
Yes
No
Don’t know
*
11.
Please indicate if you are affiliated with MADCaP, ARGO, AfRECC, etc
(Required.)
12.
Please share any other comments you have below:
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