Request Clinical Trial Support | Center for Women's Health Research at UNC

Please take a moment to complete this questionnaire regarding your interest in leading an industry-sponsored trial. This information will help the Center for Women’s Health Research determine next steps for coordination with the Office of Clinical Trials, the sponsor, and administration. Once this form has been submitted, a member of our staff will respond within two business days. If you are submitting a grant application, please use this form.

If you have any questions or concerns, please contact Jalimar Gonzalez (jalimar_gonzalez@med.unc.edu).

Lead Principal Investigator *
How did you learn of this opportunity?
Lead PI Email *
This is a:
- PI-initiated study
- UNC-initiated study that will utilize CTMG services
- CTMG-initiated study
Sponsor *

Name of Company
Sponsor Point of Contact *
Sponsor Email Address *
Email address for point of contact is preferred
Sponsor Phone Number
Phone number for sponsor point of contact is preferred
Sponsor Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Protocol # *
Protocol Title *
Projected Start Date *
Where are you in the process thus far? Have you collected any documents?
Confidential Disclosure Agreement (CDA)
Accepted file types: jpg, gif, png, pdf, doc, ppt, Max. file size: 98 MB.
Additional Sponsor Documents
Accepted file types: jpg, gif, doc, ppt, pdf, xls, xml, csv, ppt, Max. file size: 98 MB.
Budget Documents
Accepted file types: jpg, gif, doc, ppt, pdf, xls, xml, csv, ppt, Max. file size: 98 MB.
Check if:
- This industry-sponsored trial requires investigational drug services
- There is no study coordinator and trial is in need of RCMU Services
Study Coordinator Name *
Study Coordinator Contact *
Telephone or Email
Please include any other details you feel are pertinent.
Form completed by (if not PI or site-PI):