IIT Study Design Form

Please enter the requested information in the form below. Or, you may print out the document, fill out the information, attach your documents and email to investigationalstudies@indivior.com

 

All information is required.

Country / Region / Area:

Date proposal reached INDIVIOR:

Study Type:

If "Other"

Principal investigator (name, institution, contacts):

Principle investigator Email Address:

Study Title:

Background:

Primary Objectives:
1.

Secondary Objectives:
1.
2.

Endpoints:
1.
2.

Study Design:

Statistical Analyses:

Inclusion Criteria:

Exclusion Criteria:

Sample Population:

Approximate Budget:
$

Funding Requested:
$

Limitations and Study Design Limitations:

Expected Outputs: (e.g. publications, conference submissions (please name))

Estimated Study Start:

Estimated Study End:

Drug Requested (be specific as to type and strength):

Amount requested:

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