Analysis Plan Form

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Analysis Plan Form

This form is required to be submitted and approved by the SRL Study Investigators, including Dr. Shepherd, before any data is distributed to analyze for conference abstracts, journal papers or grants. Approval of the resulting work must also be submitted for review by the investigators for accuracy.

Email *

1. Which study is your Request related to? *

Shape Up! Cohort [shapeup.shepherdresearchlab.org]

Hawaii Pacific Islands Mammography Registry (HIPIMR) [hipimr.shepherdresearchlab.org]

2. Date of Request *

YYYY

3. Working Title *

4. Name of Lead Author or Investigator *

5. Last Author Request (if Known) *

John Shepherd

Steven Heymsfield

Other:

6. Potential Co-Authors *

7. Type of Request *

Abstract: Add Name and Date of Conference below

Manuscript: Add Proposed Journal and Submission Date below

Grant proposal: Add Funding Agency and Deadline below

Industry Collaboration: Add Company Name below

8. Type of Request - Add Details *

9a. Supplemental Funding - Does this study involve grant or other supplemental funding?

If yes, answer "Other" and provide details on funding source include start & end dates or upcoming grant deadline.

Other:

9b. Supplemental Funding - Does this study involve the support or collaboration of a for-profit entity?

If yes, in "Other" include what entity you have support from and/or are collaborating with.

Other:

9c. Supplemental Funding - Do you intend to use the data to patent any process, aspect, or outcome of the analysis?

Yes

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