Project Registration Form

Project Details

Project title (or provisional title):

Please define acronyms

Name & organisation of primary contact person:
Email address of primary contact:
List other key project personnel (state name & role on project):

Host WDHB department name(s) :
Expected project start date?
Anticipated project end date?
What is the question/issue this project aims to address?

Which of these best describes this project?









Briefly outline the project (what will you actually do/where will you do this) :

Please also attach a copy of your project proposal/protocol below


Enter a list of keywords:

Is this a multi-centre project? (includes other DHBs/PHOs/sites)



What type of ethics approval will/has been sought?




Does your project team include non-WDHB researchers/ contractors/ students?


Will Waitemata DHB be required to sign a contract relating to funding, resources, confidentiality or intellectual property for this project?


Resources

Tick all the Clinical Support Services you require for this project (if any):

*All protocols that include the administration of medicines to patients must be reviewed by Pharmacy







Support and Advice

Tick any Knowledge Centre services you would like to access:









Current status of your Project and any other information


Attach Files

Please upload any relevant documents here e.g. proposal, ethics approval letter, questionnaire etc.

Attach File 1:

Attach File 2:

Attach File 3:

Attach File 4:

Attach File 5: