Study Recruitment Form

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Project Title*

Main Contact*

The name of the primary contact for updates and information about this project

First Last Suffix

Main Contact Email

Main Contact Phone

Principal Investigator

First Last Suffix

Principal Investigator Email

Project Start Date

Include the date it started, or the date is projected to start.

Month

Day

Year

Approximate End Date

We understand this may be an estimate.

Month

Day

Year

Any comments on expected timeline?

Project Purpose

This is information to help us better understand the study. It is not published.

When we publicize your project, we can share it PRIVATELY and target it to the specific population through email, SMS, our private Facebook group or other private groups OR PUBLICLY such as on Facebook or Instagram or other public groups. Depending on your project the public method poses some risks. These are only for you to decide.

Dissemination Preferences

Choose all media channels we are allowed to use.

SMS

Private Groups

Publicly

⬇️ CLICK TO VIEW SOCIAL MEDIA EXAMPLES

This is verbiage to lead to more detail and is generally used in social media or in an email update snippet. We recommend 50 to 100 words.

If you or your child has NF1 and have not visited an NF Clinic Network (NFCN) clinic in the past 12 months, you may qualify to participate in an important research study. This study focuses on improving the quality of care that NF1 patients receive during annual check-ups or well-child visits. Your participation could help shape better care for the NF1 community. The research is testing two interventions to provide NF1-specific recommendations during your annual physical exam or well-child visit. It involves two online surveys and an optional interview.

Brief Social Media & Email Verbiage

This is what might appear in a social media post or an email. It works as a lead in to more detail. 50 to 100 words recommended.

May we any change wording?

Per your IRB are we allowed to change the wording of our own social media posts and/or email introductions which share your IRB-approved study materials?

Yes

Other

Media Images (used for social media)

At least one preferably square 1200×1200; other helpful sizes 1200×630; 1080×1350

Drop files here or

Accepted file types: jpg, png, Max. file size: 10 MB.

Detailed Public Description

Share exactly how this project should be described to the public. It may be used in a more detailed website post. This NOT required if you have a flyer or website but can be very helpful in allowing us to post details, while respecting your IRB. It is your full public description including requirements and study procedures. Write in the third person…ie “Not we are…” but “XYZ Institution is…”

May we any change wording?

Per your IRB are we allowed to change any wording for the full public description?

Yes

Other

Eligibility Requirements (List them here)

IE. Age, Type of NF, At least one PN

Often research flyers need to be shared as a graphic. It is helpful to have a PDF one and one in a graphic format. It is our recommendation that if you have the ability load your flyer or research project information somewhere and provide the link. That way if you have to change anything, people are getting update information. Also, we recommend putting a last revision date on material when possible.

Project Url

Flyer Url

Project Flyer

Please upload your project flyer as a PDF AND as PNG or JPG

Drop files here or

Accepted file types: pdf, png, jpg, Max. file size: 10 MB.

Comments

Please include anything else we should know to help you promote your project.

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Research Recruitment Request Form