COMSEP Annual Survey Intake Form
Please complete this form to be considered for the Annual Survey. Selected proposals will be asked to submit the following information before their questions can be included in the survey, which will go live in the Spring:
(1) Survey Questions, (2) Summary of pilot testing, (3) Documentation of IRB application/Approval.
Email address *
Date
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Investigator Name(s)
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Primary Investigator's name and email
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Problem/Topic to be addressed:
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Background/Significance to pediatric undergraduate medical education (please articulate the gap you are trying to bridge):
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Specific Aims and Hypotheses for your project:
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Intended population towards whom questions will be directed:
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Draft Survey Questions
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References:
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Attestation that the PI will obtain an IRB to conduce this research and it will be made available to COMSEP prior to survey administration.
Dissemination Plan:
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