The code block below illustrates how one might use # and // as comments in your logic and calculations.

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Required format:

Scheduler Access/PI Authorization

For those submitting a PI Shared Folder/Application Authorization Request

Please fill out the form below for all studies needing access to UCH/CHCO CTRC core laboratory, nutrition, or echo data. The CCTSI will provide the Investigator and anyone whom the Investigator authorizes either a shared folder or revelant application access.

Assay results that are analyzed in the UCH, CHCO Core laboratories and Nutrition data will be uploaded to your shared folder.

Please select one, or both, of the following request types

* must provide value

PI Authorization Request

Scheduler Access Request

Primary Contact First Name

Primary Contact Last Name

Primary Contact Email

Is this a new request or an update to an existing PI Authorization record?

* must provide value

New

Update

reset

Files needed for this protocol

* must provide value

UCH Core Laboratory Results

CHCO Core Laboratory Results

Nutrition Information

Diet Diary Upload Folder

BioImaging Results

Only the PI may complete this form to gain access for themselves and designated study staff for protocol access in CTRC Scheduler. One form is required per protocol as the study staff assigned to different protocols, even for the same PI, may differ. Thank you.

Is this a new request or an update/change request for Scheduler?

* must provide value

New Request

Change Request

reset

What is the nature of the change that you are requesting (eg remove user, add user, change permissions) for Scheduler?

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Please list the UCD email addresses of all study staff that will need access to this protocol in CTRC Scheduler, each separated by a semi-colon.

* must provide value

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Scheduler PI warning

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Protocol number (COMIRB, other IRB, or equivalent study number only)
______

* must provide value

Protocol Title

* must provide value

Principal Investigator (PI) First Name

* must provide value

Principal Investigator (PI) Last Name

* must provide value

Principal Investigator (PI) Email

* must provide value

Principal Investigator (PI) Phone

Principal Investigator (PI) Username (e.g., brownt)

* must provide value

PI Affiliation

* must provide value

PI Department Affiliation

* must provide value

PI Division or Section

First Co-Investigator Name

First Co-Investigator Email

Second Co-Investigator Name

Second Co-Investigator Email

Third Co-Investigator Name

Third Co-Investigator Email

Fourth Co-Investigator Name

Fourth Co-Investigator Email

Fifth Co-Investigator Name

Fifth Co-Investigator Email

First PRA/Study Coordinator Name

First PRA/Study Coordinator Email

Second PRA/Study Coordinator Name

Second PRA/Study Coordinator Email

Third PRA/Study Coordinator Name

Third PRA/Study Coordinator Email

Fourth PRA/Study Coordinator Name

Fourth PRA/Study Coordinator Email

Fifth PRA/Study Coordinator Name

Fifth PRA/Study Coordinator Email

Please sign using your mouse, or your finger on touchscreen computers, to verify that the study staff you have designated to have access to this protocol in CTRC Scheduler will have access to PHI for all participants in this protocol.

* must provide value

Add signature

Please enter any additional comments on your PI Authorization request below:

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date_entered

Y-M-D

Change notes

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