Request for Assistance

If you would like to request assistance from the Center for International Research Assistance and Support, please complete the general electronic request below and. After completing this form, click the "Submit Form" button at the bottom of the page. You should receive a confirmation email indicating that we have received the form, and a CIRAS staff member will contact you as soon as possible.

Please provide the following information:

Protocol Title:
SEA-001 Oseltamivir for Treating Severe Influenza
SEA-002 Oseltamivir on Healthy Volunteers
SEA-003 Pharmacokinetic & Intravenous Zanamivir

Protocol Assistance related to selected protocol:
Biostatistics
Data Management
Laboratory
Pharmacy
Quality Management
Regulatory
Site Study Preparation
Other (please clarify in description box below)

General Network Assistance:
Administrative
Meeting Planning Support
Operational/Organization
Site Support & Development
Training
Other (please clarify in description box below)

 Brief description of need:

Person requesting assistance:
First Name *required field
Last Name *required field
E-mail Address *required field
Telephone Number
Role on Study
 

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