Post-Award Request Form

Project title*

IRB number*

Is this project cancer related?*

Yes
No

PI Name*

First Last

UFID*

Email*

Department*

Institution*

Phone

Are you a UF Health Cancer Institute member?*

Yes
No

If yes, what is your research program alignment?

Cancer Control & Population Sciences (CCPS)
Cancer Targeting and Therapeutics (CTT)
Immuno-Oncology and Microbiome (IOM)
Mechanisms of Oncogenesis (MOO)
Not programatically aligned

Are you an NIH-defined Early Stage Investigator (ESI)?*

Yes
No

ESI definition

Does this project involve e-Health (e.g., Digital Health, Mobile Health, Telehealth, Web-based eHealth)?*

Yes
No

eHealth Support Requested Area (select all that apply)

Patient-reported data collection (survey)
Prototyping and co-design
Usability testing
Workflow analysis
Analysis of existing user-centered design data
Mobile app development
Advanced technologies (e.g., wearables, physiologic data capture, virtual/augmented/mixed reality, etc.)
Virtual education or training/eLearning for patients
Other eHealth service

Specify type

Survey/PRO data
Interview or focus group data
Observation data

Other eHealth service

Does this project involve Natural Language Processing (NLP)?*

Yes
No

Project data source*

SEER-Medicare
UF Health Integrated Data Repository (IDR)
OneFlorida+ Clinical Research Consortium
Florida Cancer Data Systems (FCDS)
Other (describe below)

Other (please describe data source)

Study population (example: breast cancer patients)*

Study outcome (example: mortality, adjuvant treatment patterns)*

Research question*

Specific Aim 1*

Specific Aim 2*

Secondary Aim 1

Secondary Aim 2

Hypothesis 1*

Hypothesis 2*

Outcome of the CISR service*

Abstract submission (conference presentation)
Journal/conference paper submission
Proposal submission
Other (describe below)

Other outcome

Have you already obtained funding?*

Yes
No, but I have already applied for funding
No, but I plan to apply for funding
No, I will not seek funding

The initial consultation is provided at no charge. After that, an hourly rate of $167.40 for data analysis and $151.50 for development applies.

Attach proposal draft or other pertaining documents (max of three files).*

Drop files here or

Max. file size: 125 MB, Max. files: 3.

At least one file is required.

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Post-Award Request Form | Cancer Informatics Shared Resource (CISR)

Cancer Informatics Shared Resource Data Science Services Request Form