Research Participant Recruitment Assistance Form

participants study (less

Project title or description:

Applicant Name

First

Last

Date of application:

Your position

Research institution:

Phone

Institution(s) where research is to be undertaken:

Who is funding this research project?

Lay language description of project and purpose (less than 100 words):

When did/will the project commence and by when will it be finished:

Does the project have ethics approval? If so please attach approval confirmation and evidence of the approved recruitment strategy.

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Please define the cohort of participants that you are seeking to recruit to this study (include demographics, number of participants, etc):

How would you like HeartKids to promote the participant recruitment to our community:

Please attach project summary if available:

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