浙医二院临床研究中心科研人员申请单 English Version.doc

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1、浙江大学医学院附属第二医院临床研究中心1869TheSecondAffiliatedHospitalofZhejiangUniversitySchoolofMedicineClinicalResearchCenterRegistrationFormforStudent/InvestigatorConductingResearchinClinicalResearchCenterNameCategories□UndergraduateStudent□GraduateStudent□VisitingStudent□Staff(EmployeeID：)PhotoPhone

2、DepartmentSupervisorProjectNameSourceofFunding(#)PrincipleInvestigatorPeriodforAboveResearch(YYYY/MM/DD-YYYY/MM/DD)FundPrepaid2500RMBResearchOutline:Assists/SupportsNeededFromClinicalResearchCenter:Ihavereadcarefullytheregulations/rulesoftheClinicalResearchCenter,andhavebeeninstructed

3、forlaboratory-safety,self-protectioninworkandproceduresformedicaltreatmentinemergency.Iwillfollowallhospitalandlaboratoryregulations/ruleswhenconductingmyresearchinClinicalResearchCente匚Phonesforemergency:6655555,Infection:3964.Student'sSignature:Date:Iagreethattheaffiliationsofbothth

4、e1standcorrespondentauthorsforanyresultingpaperwillbetheSecondAffiliatedHospital,ZhejiangUniversitySchoolofMedicine・Supervisor'sSignature:Student'sSignature:Date:Iconfirmtheidentityoftheabovestudent/investigatorandtheresearchtobeconductedinCRC.Signature(Supervisor/PrincipleInvestigato

5、r):Iconfirmthestatusoftheabovestudent/investigatorandresearchproject.Signature(DepartmentofResearch&Education):Iwillarrangetheabovestudent/investigatortoconducthis/herresearchinthislab.Signature(ClinicalResearchCenter):浙江大学医学院附属第二医院临床研究中心1869TheSecondAffiiatedHospitalofZhejiangUnivers

6、itySchoolofMedicineClinicalResearchCenterApplicationfortheElectronicAccessForEnteringClinicalResearchCenterIhavefinishedtheorientation/trainingcoursebyClinicalResearchCenter,andnowIamapplyingfortheelectronicaccesstoenterClinicalResearchCenter.Iwillfollowalltheregulations/rulesofthelab

7、,andwillnotlendtheAccesstoanyoneorbringanyonewhohasnoaccesstotheClinicalResearchCenterintothelabwithoutpermission.Itakefullresponsibilityfortheconsequencesduetomyviolationoftheregulations/rules.IwillinformtheadministrationpersontocancelmyaccesswhenIfinishedmyresearchworkinClinicalRese

8、archC