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COVID-19 Study Staff Support Registration
Staff Name (First)
Staff Name (Last)
School:
Department:
Phone Number (Direct Contact):
Email Address:
Remote Access via VPN?
Yes
No
Mednet Access?
Yes
No
WebIRB Access?
Yes
No
OnCore Access?
Yes
No
CareConnect Access?
Yes
No
Description of current role (10 words)?
Name of PI you work most closely with?
Name of person you directly report to?
Current Work Status?
In what areas do you think you have the skills to provide support (check all applicable)?
IRB Submission
Study Activation
Research Coordinator
Nurse Coordinator
Phlebotomist
Regulatory Support
Data Entry Support
Biostatistical Support
Engineering Support
Population Health Support
Precision Medicine Support
Computational Medicine Support
Other (e.g. Laboratory Support, etc. - please indicate)
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