Clinical Research Recruitment Advertising Questionnaire

IRB Protocol Number

 Pending Have a number:

In lay terms, what is the focus or goal of this study?

What will participants be asked to do?

People may be eligible for this study if they?

Will participants be compensated for time and travel?

 No  Yes

Who is the study director or principal investigator?

(Name, credential, department/division)

Who is the study coordinator?

(Name, department/division, extension)

Who is the study contact person? (if different than study coordinator)

(Name, department/division, extension)

Is this study grant supported or industry sponsored? (for Marketing and Communications purposes only)

  Grant supported  Industry sponsored

Does this study have an advertising budget?

(Marketing and Communications has budget resources set aside for clinical trial recruitment, especially in the case of a trial with broad eligibility criteria but no advertising budget.)

 No  Yes  budget pending

If yes, please provide an estimate:

How many participants does this study need to enroll?

How many people do you expect to screen locally to meet your enrollment target?

Will this study be promoted by an independent advertising agency arranged by the sponsor? (select one)

No (please continue to the next question)

Yes (please list a contact name and number for that agency and skip the last section)

If the agency will only provide certain advertising components, please fill out the section below for other materials the study may require, e.g. internal flyer, etc.

Please e-mail any materials to Clinical Research Advertising with your IRB# and the words "ad materials" in the subject line.

Please check the boxes next to the type of advertising you would like to use for this study:

(Samples of each of the following are available on the Marketing and Communications Website.)

I prefer to have Marketing and Communications recommend advertising formats based on the information I’ve provided above
Clinical Trials Office and departmental Web site listing (can be same design as flyer)
Daily newspaper ad
Weekly community circulars ad
Internal/clinic flyer
Direct mail to referring physicians
On hold message
Print Newsletter blurb
PSU News Wires
Radio spot
TV spot
Study brochure
 

Please select one:

I have an image I would like incorporated in the design.

Please e-mail images to Clinical Research Advertising with your IRB# and the words "ad images" in the subject line or copy and paste the url of the image here

I want the designer to select an appropriate image for my review.

I do not want any images on this flyer.

Will Marketing and Communications print these? (Requires two additional days for processing) Click here for Clinical Research Print Request Form

Yes No

If yes, please list:

Please supply a pull-day date (estimate open enrollment time)

Quantity needed

Where they should be delivered when ready

Please only select the "Submit Form" button once.  You will receive a confirmation page. 

Questions may be directed to Clinical Research Advertising.