TOPAZ Account

Principal Investigatior Information

Name*

First Name Last Name

TSU Email*

Best Contact Number*

Best Contact Number Type*

Alternate Contact Number*

Alternate Contact Number Type*

Subject/Participant Type*

College or School*

Department*

I am a TSU*

Protocol Reviewer Information

This section is required to be completed by all TSU principal investigators.

Faculty Reviewer Name

First Last

Faculty Reviewer Role (e.g., Advisor, Committee Chair, Committee Member, etc.)

Faculty Reviewer TSU Email

Faculty Reviewer Contact Phone

CITI Program Membership

Are you a member of the CITI Program Online Training?*

Confidentiality Agreement*

I acknowledge and agree that I shall keep secret all confidential and proprietary information and not reveal or disclose it to anyone unless required by my supervisor or a University official to do so. I agree that if I commit a breach of this agreement, the University shall have the right to take disciplinary action against me and to otherwise enforce this agreement.

Yes

Applicant Signature*

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If you want to delete it and try again simply press "Clear" icon in the bottom right corner.

Date*

TOPAZ ACCOUNT REQUEST

Principal Investigatior Information

Protocol Reviewer Information

CITI Program Membership