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* 1. Your name

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* 2. Organization

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* 3. Email Address

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* 4. Proposal Title:

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* 5. Principal Investigator/ Site (please list co-investigators from other sites):

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* 6. Hypothesis:

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* 7. Practice Gap:

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* 8. Data needed from VCSQI

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* 9. Intended Meeting and Submission Deadline:

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* 10. By checking this box, I agree to present the study findings to the VCSQI membership at a quarterly meeting upon completion of this proposal,

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