Questionnaire regarding potentially becoming a D43 Participating Institute

Question Title

* 1. Contact Information

Name *

Institution *

City/Town

State/Province

Country *

Email Address *

Question Title

* 2. Does your institution have an ethics board or institutional review board (IRB) that oversees research protocols?

Yes

Don’t know

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* 3. Does your institution have active cancer research projects and researchers?

Yes

Don’t know

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* 4. If yes, what areas of research are being undertaken at your institution? (Check all the apply)

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)

Question Title

* 5. Are any of the following disease areas the subject of active research at your center?

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)

Question Title

* 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

Yes

Don’t know

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* 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?

Yes

Don’t know

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* 8. Has your institution received grant funding from outside funders?

Yes

Don't know

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* 9. If yes, what funding sources have been previously held grants at your institution?

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)

Questionnaire regarding potentially becoming a D43 Participating Institute

Question Title

* 1. Contact Information

Question Title

* 2. Does your institution have an ethics board or institutional review board (IRB) that oversees research protocols?

Question Title

* 3. Does your institution have active cancer research projects and researchers?

Question Title

* 4. If yes, what areas of research are being undertaken at your institution? (Check all the apply)

Question Title

* 5. Are any of the following disease areas the subject of active research at your center?

Question Title

* 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

Question Title

* 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?

Question Title

* 8. Has your institution received grant funding from outside funders?

Question Title

* 9. If yes, what funding sources have been previously held grants at your institution?

Question Title

* 10. Is your institution registered in the US grant system (i.e., does your institution have a DUNS number, FWA, etc)

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* 11. Please indicate if you are affiliated with MADCaP, ARGO, AfRECC, etc

Question Title

* 12. Please share any other comments you have below: