Washington University in St. Louis, School of Medicine, Division of Biostatistics
Request for REDCap Project Account
REDCap is a secure, web-based, clinical studies management system used for building and managing the forms and underlying databases needed for your clinical research project. REDCap Survey is a powerful tool for building and managing online surveys. To use REDCap to manage your study, a REDCap Project Account must first be requested from the Division of Biostatistics. Once the Project Account is set up, each individual user must request a REDCap User Account from the Division of Biostatistics.
Note: Requests for REDCap project accounts must be approved by the Principal Investigator of the applicable study (refer to Section II).
Section I: Project Information – To request a REDCap Project Account, please complete all fields in Section I, below, and then forward this form to the Principal Investigator for approval (see Section II). Please Print.
Project Title:
Principal Investigator (First name)______(Last Name)______
Institution: [ ] WU [ ] BJH [ ] SLCH [ ] Other:______
Division / Department:
Address (include campus box #):
City: State: Zip Code:
Phone: Email:
The Project Administrator (PA) is a REDCap user who has the authority, along with the PI, to create databases, give database access to other users, and assign user rights to users. Please have the PA complete a user-account application if he or she does not already have an account.
Project Administrator (First name)______(Last Name)______
Address (include campus box #):
Phone: Fax: Email:
Section II – Authorization (to be completed by the Principal Investigator)
Terms of Agreement for REDCap project account: I agree to follow all REDCap policies as outlined at http://www.biostat.wustl.edu/REDCap, particularly those related to downloading data. I affirm that I have completed all necessary Human Studies and HIPAA training required and that if this is a research project that it has been approved by HARPO. I agree to keep all information confidential. I agree to safeguard my data in compliance with HIPAA policies. I agree to safeguard my Username, Password and Workstation Account, and not make them available to any other person. I agree to acknowledge support from the ICTS and SCC support grants in any publications utilizing data from REDCap.
Signature of Principal Investigator: Date:
Section III (Biostatistics use only) RT Ticket Number:
Project Name Assigned: Date Assigned:
Date Removed:
Please email the completed form to .
Division of Biostatistics, Washington University in St. Louis, School of Medicine, Campus Box 8067, 660 S. Euclid, St. Louis, MO 63110-1093; Phone (314) 362-3154; Fax (314)362-3440.
REDCap Project Account Request Form_20091116