Request for Trial Support

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Thank you

Email *

Local contact job title *

Research Team

Address *

Local contact telephone number *

Study details (name and CPMS number). Please note studies must be on the NIHR portfolio to receive support. *

Are any of the studies commercial? Please be aware we may need to recover costs for time spent supporting commercial studies, this will be discussed with you prior to agreeing a placement. *

Yes

Name of senior nurse or manager in local R&D that this support request has been discussed with (if not the person making this request)

Summary of situation ( to include details of why the support is needed and how the current situation is planned to be resolved) *

Is the placement to support any of the following studies? *

National priority studies

High throughput studies

Non NHS research

Research with underserved communitites

Collaborations between secondary care and primary care and/or non NHS sites

Vaccine Innovation Pathway

Primary Care study

Other:

Required

What specific tasks will you require from staff e.g. rating scales, clinical duties, data collection *

Which staff role/roles would you like support from? *

Clinical Research Nurse

Clinical Research Practitioner

Clinical Trials Administrator

Required

Is a Letter of Access or Memorandum of Understanding required? *

LoA

MOU

N/A within MFT

Preferred start date for support? *

YYYY

Days per week requested *

Length of placement request (this should be for a short period of 6-8 weeks initially) *

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