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Registration for initial consultation
Registration for the initial statistical consultation for the project named below
(Follow-up appointment, if needed, please schedule directly with your primary consultation)
The fields marked with * are required for registration, otherwise your request cannot be processed.
Salutation
Frau
Herr
Title
Name
*
Firstname
*
Telefonnumber
*
E - Mail
*
( supporting ) institution
*
Title of the project / work
*
Use of the results
*
Dissertation
Habilitation
Forschungsprojekt
Klinische Studie
Publikation
Förderantrag
If this is a clinical trial, please indicate the regulatory setting.
Arzneimittelgesetz
Medizinproduktegesetz
unklar
nicht zutreffend
Does a cooperation with the Center for Clinical Studies (ZKS) Jena take place?
nein
geplant / laufend
schriftlich vereinbart
nicht zutreffend
Is there an application process to the Ethics Committee for your project?
nein
geplant / laufend
positives Votum erteilt
unklar
Is there any support from third partners?
nein
DFG
BMBF
Industrie
andere
Current status of the project / work
*
Planung / Vorbereitung
Datenerhebung
Auswertung
Arbeit fast (druck)fertig
other remarks
Information on the collection of personal data
Privacy policy to DSGVO
Ich habe die Datenschutzerklärung und die Information zur Erhebung personenbezogener Daten gelesen und stimme der Erhebung meiner personenbezogenen Daten zu.
I accept.
*
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