Requesting EMBARC-BRIDGE Datasets

REQUEST EMBARC-BRIDGE DATASETS

Application to Access EMBARC-BRIDGE Datasets

or information: not

Name

First

Last

Institution / Organisation

Position

Contact Number

Date of Request

Disclosure and conflicts of interest:

Please disclose any potential conflicts of interest and associations with private companies, especially pharmaceutical companies. Conflicts should be disclosed even where the applicant considers these not to be relevant to the present application.

Data / information requested:

Title, AIM and brief description of the project, activity or purpose for which the requested EMBARC-BRIDGE dataset will be used.

List intended uses of the data or information:

(incl. anticipated publications, reports, presentations, analyses etc).

Funder (please state sources of funding, or state project not funded):

Is statistician support requested for this study?

Date required (if relevant):