Protocol Submission Checklist

The checklist used by the Pediatric CTRC to verify completion is below.
If you would like a printable copy,please click here for a copy of the Word document (.doc)

Protocol Title:________________________________________________________

PI:_______________________________

Date Checklist Completed ___________________

**Protocol Application Checklist**
ITEM	DATE RECEIVED	NOTES
Current e-application
Full protocol � if applicable
Consent form � draft or final
Budget (if NIH, industry etc)
COMIRB application / submission
Radiology Request (if appl.)

Proceed to SAC? Yes No

**Protocol Section Checklist**
Section	Present	Absent	Date	Notes
Cover Page
Abstract
Hypothesis & Specific Aims
Background & Significance
Preliminary Studies
Research Design & Methods Sections A � N
Human Subjects Sections A-D
CTRC Resource Justification
Appendix 1 � Resource Summary
Appendix 1 � Resource Summary
Appendix 2 � Ancillary
Appendix 4 � Signature
Subject Catagories
DSMB
Funding Sources
References
Appendix 3 - Axis codes

Proceed to SAC? Yes No

RSA___________________

Possible Reviewers__________________
__________________

__________________

Mentor Required? Yes No

Mentor Notified to Attend SAC? Yes No

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