In order to utilized PediPERForm Learning Network (PLN) data for research or quality initiatives, please complete the data request form below. Once your submission is received, it may take up to 3 months for completion of the SRC analyses, depending on scope and complexity. Should one exist, the SRC may encourage participation in a similar or closely related proposal submitted by other investigators. Once the review is complete, the SRC will contact the PI with approval or recommendations and share next steps in the process.

All applications must be accompanied by a concise, informative Research Plan that will be reviewed by the SRC. The Research Plan should generally adhere to the following format:

Research Plan (5-6 pages)

1. Study Background
2. Overview - Hypothesis/Aim
3. Study Plan/Approach
3.1 Study Patients
3.1.1 Study Inclusion Criteria
3.1.2 Study Exclusion Criteria
3.2 Statistical Methods
3.3 Timetable for Executing the Study
3.4 Dissemination Plans

PLN strongly encourages the investigators to target AmSECT and JECT as the meeting and publication forums, for dissemination of PLN based research.

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* 1. First & Last Name

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* 2. Credentials (e.g., CCP, MD, PhD)

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* 3. Title

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* 4. Phone

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* 5. PI Email

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* 6. Confirm PI Email

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* 7. Institution

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* 8. Institution Address

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* 9. Is the PI the corresponding author?

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