Collaboratory Epct Training Workshop Application

Collaboratory ePCT Training Workshop Application The purpose of this workshop is to (1) train investigators in the design and conduct of embedded pragmatic clinical trials (ePCTs) and (2) pilot the educational materials and collect feedback on their quality and appropriateness from both the attendees and the subject matter experts. Travel, lodging, and food costs for the attendees will be covered.

INSTRUCTIONS Before you begin the application: 1. Review the questions attached here to ensure you have all the relevant information on hand before beginning the online application process.

2. Complete the application sections listed below. You will need to provide the following information: a. Applicant contact information b. Nominator contact information (name, institution, and email)

3. Provide completed versions of these documents as part of the application: a. Proposed specific aims for an embedded PCT - Please list one or more specific aims for an embedded PCT that you would use as an example to facilitate your learning during the workshop. The aims could be for an actual trial you wish to conduct or for a hypothetical trial related to your area of expertise. b. Provide SF424 Biographical Sketch form of applicant c. Letter of support from a healthcare system, colleague, or sponsor

4. To describe your motivations and also to ensure a good match between your interests and the objectives of the workshop, please respond to the question below.

Why are you interested in attending the Training Workshop?

Please ensure that you have all appropriate information and documentation on hand before starting the application at the link below. https://duke.qualtrics.com/jfe/form/SV_02LFpq6A1GmekGV Incomplete forms will not be reviewed or considered by the Training Workshop Committee. Applications must be submitted no later than December 15, 2017. If you have any questions about this form, please contact the Collaboratory Coordinating Center at [email protected].

Collaboratory ePCT Training Workshop Application Final Page 1 of 2 Collaboratory ePCT Training Workshop Application Final Page 2 of 2