St James's Hospital, Research & Innovation Office Application Form

*** NOTE: You must fill in this form in full in order for your application to be submitted successfully *** Do not begin your study until you receive an official approval email from the Research and Innovation Office.

1. SUBMITTED BY / CONTACT FOR THE STUDY
Full Name:		Email Address:
Contact No:		Department:
Organisation:		Work Position:
2. SJH PRINCIPAL INVESTIGATOR / SJH SUPERVISOR
Principal Investigator Full Name:
3. CO-INVESTIGATORS / RESEARCH TEAM (add if applicable)
Full Name:	Work Position:	Organisation:	Role on Study:
4. TITLE OF STUDY (max 120 characters)
5.1 PURPOSE OF PROJECT (Choose 1)	To generate new knowledge	Review of current practice/quality improvement

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