<p> StudyManager Account Request Form Instructions</p><p>1. All of the fields below are required to obtain a StudyManager account. 2. Complete the form, and then save it to your computer. E-mail the completed form, as an attachment, to your Supervisor/Investigator with a request to forward to Clinton Vickers. 3. Supervisor/Investigator should authorize the account request by forwarding the e-mail, with the completed form as an attachment, to Clinton Vickers: [email protected].</p><p>What does authorization of the account request mean? For Research Staff account requests: Investigators/Supervisors: Forwarding this form to Clinton Vickers indicates your authorization for: 1. The actions requested in this form. 2. The individual indicated in this form to have StudyManager access to any study for which the individual is listed either as the primary study contact or as a back up. 3. Those with StudyManager access to your studies to officially document completed study procedures and confirm the billing direction for those events in the context of Children’s research billing compliance program. For Administrative or Support Staff account requests: Supervisors: Forwarding this form to Clinton Vickers indicates your authorization for: 1. The actions requested in this form. 2. The individual indicated in this form to have StudyManager access to all the studies necessary for the completion of their job responsibilities. 4. Account will not be activated until requestor has completed StudyManager training. Requestor will be contacted by the Clinical Research Support Office (CRSO) to schedule training. 5. For help with questions about this form, email: [email protected].</p><p>Requestor Information Name: Phone: New Account Modify Account Termination Department(s): Role: (select one) If other selected, define role: </p><p>Date Account Needed or Account Modification/Termination Effective: </p><p>Name of Supervisor/Investigator of Requestor: </p><p>Related Policies: CTM-100 StudyManager Utilization and Compliance CTM-101 StudyManager Security</p><p>Clinical Research Support Office (CRSO) Revision Date: 2 December 2008</p>