Submit to: Research Approval Coordinator, Research and Performance Support
Room M-704, Wascana Rehabilitation Centre
2180 - 23rd Avenue, Regina, SK S4S 0A5
(306) 766-0893
REDCap Access Request1.1 / Project Title:
Abbreviated Title (if applicable):
Anticipated Start Date (mm-dd-yyyy): Anticipated End Date (mm-dd-yyyy):
1.2 / Principal Investigator:
Full Name:
Email Address: Telephone Number:
Department:
1.3 / Project Personnel:
Full Name:
Email Address: / Full Name:
Email Address:
Full Name:
Email Address: / Full Name:
Email Address:
Full Name:
Email Address: / Full Name:
Email Address:
Full Name:
Email Address: / Full Name:
Email Address:
Principal Investigator Agreement
** A signature is required by the Principal Investigator (PI) or their delegate to get permission to create projects in REDCap.
· I have reviewed the REDCap Terms of Service for the Regina Qu’Appelle Health Region and agree to abide by it.
· I have reviewed the Terms of Use for the REDCap Non-Profit End-User License Agreement which describes the terms of the agreement between Vanderbilt University and the Regina Qu’Appelle Health Region.
· The lists of the persons whom I wish to have access to the software are listed on page 1 of this form. I will permit these users to have access to the project(s) and I will oversee and remove their access when that permission is no longer required.
· I will resubmit a new REDCap Application to the Operational Approval Co-ordinator () when:
o new members are added
o a person has left my group, or no longer requires access to REDCap.
o I am developing a new project separate from the one on this application
I recognize that it is my duty to take ownership and ensure REDCap is used for its intended purposes by both my team and I.
Signature of Principal Investigator:______Date:______
Please complete this form and submit it electronically to the Research Approval Coordinator.
The signature page can either be submitted as a scanned PDF page of a hand written signature or as a hard-copy page mailed to the Research Approval Coordinator (M-704, WRC)
Version 1.0 dated August 31, 2017 Page 1 of 2