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BHrrNoYraYmFJ6fM6qfvovAhw2dtHzqMfCbcj7xBndh

MATR Project Proposal Form

Please respond to the following intake form. This allows our staff to become familiar with your general needs. We understand that you may not know all the details at this time, and we will follow up to clarify any necessary information during our consultation meeting.

Thank you!

Today's Date:

M-D-Y

Study Title:

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Name:

* must provide value

Title:

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Affiliation:

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Phone:

Email:

* must provide value

Has this project received funding?

* must provide value

Yes

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Are you planning to apply for funding:

Yes

Possibly

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Please provide a description, including the estimated submission date:

Source of Funding:

Amount of Funding Allocated for the MATR's services (approximate):

Is this a just in time submission?

(ie. Do you need MATR to create an IRB submission before you receive grant funding? Fees may apply if so.)

Yes

I don't know

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Proposed start date:

Month:

Year:

Proposed study duration:

Do you already have a protocol approved through your institution's IRB?

Yes - Please send the MATR your approved documents

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Please upload your approved documents:

Upload file

Please type your name indicating that you agree to MATR's review of your documents:

Please describe your study in detail, including research methods and design as well as study involvement for participants:

(You can either copy and paste the text into the box or upload a document below)

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Upload file:

Upload file

What services do you need from the MATR:

Access to data for secondary data analysis

Access to work with MATR participants for a primary data collection project

Other

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Please describe the data that would you like to access. Provide as much detail as possible:

If you are unsure, please indicate this so that we can offer additional guidance.

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MATR's role:
Please expand on how you would like MATR to collect data, recruit, screen, and/or collect samples for your study.
Be sure to include such things as how you would like the MATR to collect data or recruit (mail, phone, email), whether the MATR needs to screen twins for your study (based on study inclusion/exclusion criteria), whether the MATR needs to collect samples and/or other data for your study, etc.

Please be detailed in your description of the MATR's role.

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Please describe:

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Data Use and Duration:
Please describe how the twins' information will be used by your study and for how long you will need to keep the twins' identifying information and DNA samples.

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Check all boxes that apply:

Twins only

Twins and family members

Higher order multiples

Please specify whether you need both twin members of a pair to take part or if one twin member of a pair is sufficient:

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Twin Ages:

Adult twins (ages 18 and older)

Juvenile twins (ages 0 to 17)

Adult twins age range:
(Ages 18 and older)

Juvenile twins age range:
(Ages 0 - 17)

Twin Zygosity:

(Please note that the zygosity information in MATR's records is not always clinical. If you need clinical zygosity determination for your analysis, please plan to include this in your project design)

Monozygotic twins

Dizygotic twins

Monozygotic pair sex:

Female/Female

Male/Male

Dizygotic pair sex:

Female/Female

Male/Male

Male/Female

Can you please describe the racial and ethnic distribution that you would like to have in the twins that complete your study:

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If there is specific ideal distribution and/ or information about ancestral lines within race categories, for instance, Northern European, North African, Mediterranean, Puerto Rican, Mexican, etc. Please describe:

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Do you require the participation of any relatives of the twins?

Yes

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If so, please describe what relatives and what study participation would entail.

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Goal number of twins (pairs) and breakdown by demographics if applicable:

(Keep in mind that the MATR will need to contact more twins than your target number of twins. Some twins will refuse to participate, will not have accessible contact information, etc.)

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Additional eligibility and exclusionary criteria:

Eligibility criteria:

(Include percent of general population who will pass inclusion criteria)

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Exclusion criteria:

(Include percent of general population who will be excluded due to these criteria)

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