POPLAR Project Intake Request Form

Please do your best to complete it. If you run into issues or are having challenges completing it, please email the POPLAR Research Coordinator at info@poplarnetwork.ca.

These are the criteria that all POPLAR projects must meet. When completing this form, please ensure that you have addressed how it fulfils these requirements:

Project Relevance: The project should be relevant to primary health care. It should have the potential to improve patient health and/or health services. Clear justification is required for the importance of the question (e.g. incidence, prevalence, costs, etc.).

Methodological Soundness and Feasibility: In terms of the methods being appropriate for the question(s), the proposed recruitment timeline, having proposed sufficient funds (and other resources) to successfully complete the project, and being ethically sound (ethics approval process must be identified, if deemed appropriate).

Study Team: A faculty member affiliated with one of the POPLAR networks should be on the team.

General Request Details

Project Title

Short Project Title

Name of Principal Investigator (PI)

Position of PI(s)

Institution/Organization of the PI(s)

Contact Email

Phone Number

Co-Investigators

POPLAR Affiliated Investigator

POPLAR Affiliated Investigator's Email

POPLAR Affiliated Investigator's Contact Number

Study Team Name (if applicable):

Support Required

What type of request are you submitting to POPLAR?

ICES Project

Third Party Research Project (via ICES Data & Analytic Services (DAS))

Letter of Support (LOS) *If a LOS is received at the grant stage, requestors don't have to submit a separate request for data if their grant is successful*

Project Description

KEY WORDS (Insert up to 5 words)

SUMMARY (500 words max) Describe your project, including objectives and methods.

SIGNIFICANCE (500 words max) Describe the significance of your project to primary health care.

ESTIMATED PROJECT TIMELINE

Anticipated START date

Year

Month

Day

Anticipated END date

Year

Month

Day

Funding and Costs

Please note that there is a fee for accessing POPLAR data. For more information on project fees, see the POPLAR website: https://www.poplarnetwork.ca

How is the project being funded?

No Funding

Grant: Please specify in text box below

Contract: Please specify in text box below

Other: Please specify in text box below

Please specify how this project is being funded:

Please list potential conflicts of interest, if any.

Ethics and Operationalization

Please select the appropriate Ethics status for your project:

ICES Project (EPM): REB exempt

Third Party Research Project or ICES Research Project: REB required

If your project requires REB, please indicate your REB approval status:

Research Ethics Board (REB) approval obtained

Pending REB approval

Please specify which REB has approved the project/submitted to:

Dissemination

Do you plan to publish the results?

Yes

If results are not to be published, how will the results be made available in the public domain?

Other

Please upload the following: a. Completed or draft study protocol for the project.

b. Any applicable details specifying objective and methods including study protocol covering multiple analyses, REB approval letters, waivers, budget justification, budget breakdown or any other relevant details.

If you experience any issues trying to upload the file, please email the POPLAR Research Coordinator at: info@poplarnetwork.ca

Please upload up to five files in PDF or MSWord (max file size 1000MB).