ISN Clinical Research Program—Regional Coordinator Submission Form

Applying for the Clinical Research Program (please see program guidelines for more detailed information)

Fill out this form, save it as a .docx or .pdf file, and submit it to your Regional Coordinator via email by March 1.

Your Regional Coordinator will review your proposal, and may send you feedback or ask you to make changes.

If they approve your proposal, your Regional Coordinator will send you a letter of recommendation. You must then submit your full application, including that letter, on the ISN Programs Application Platform by May 1.

Section 1: Basic Information

Name of Principal Investigator:

Principal Investigator Title:

Principal Investigator Email Address:

Proposed Project Title (maximum 10 words)

In which country/countries does your project take place?

Coordinating Organization (Center/Hospital/University)

Coordinating Organization City and Country:

Where do you consider yourself to be in your research career?

☐ Early Career	☐ Mid-Career	☐ Established Career

Do you currently have access to local experts or mentors in the field related to your proposal?
☐ Yes ☐ No
If yes, please list up to 2–3 individuals and their roles:

I confirm that the Principal Investigator and all co-investigators that will be listed on the proposal are full and current ISN members. ☐ Yes

Section 2: Structured Abstract

Please complete the below one-page structured abstract. For your information, these section headings correspond with the scoring criteria used to select funded CRP projects. Please be brief; this form is intentionally kept to a maximum of one page.

Research Objective & Rationale. Clearly state your study objectives and hypothesis, the knowledge gaps you are trying to fill, the relevance to local healthcare needs, and what this study will contribute to future research. (400–500 characters)

Study Design & Methodology. Provide a brief description of the study design and type, the study population and any comparison groups, and the primary and secondary outcomes. (900–1,100 characters)

Feasibility & Institutional Support Briefly describe the institutional support available for the project, the roles and responsibilities of the research team, the feasibility of completing the project within the proposed timeframe, and the overall timeline. (300-400 characters)

Budget Summary Provide a concise justification of the proposed budget, limited to essential study needs and excluding unnecessary overheads. (150-250 characters)