The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

Ss2jszA6hXyLE5GVWnZYJWgIz7IxEnZRVNSY4bEHjTtBQt3QS9K34jGCmrMsQyGAhme4R26sHDYA36heNmhNPkt8BbYMqJcSEgfjn9m8ysceHipE6bM8BuSSHV

Redcap Account Agreement Form

Returning?

A A A

Please answer all the questions below.

*IF YOU HAVE ALREADY COMPLETED THIS FORM, DO NOT SUBMIT ANOTHER ONE

For support, please email REDCap@gwu.edu

Participant ID

I'm requesting

* must provide value

Full REDCap Access (George Washington University Users Only)

Non-GWU Access (Affiliates and Collaborators)

reset

*Non-GW Access users can not create or copy projects. Users can be added to projects by their sponsor or PI from GW.

Visit here to learn more inforamtion about external collaborators and how to access GW REDCap.

I am currently affiliated with GW or CNMC or part of a project where the sponsor or PI is affiliated with GW or CNMC.

Or a current employee of GWU or GW MFA or currently enrolled as a student.

* must provide value

Yes

I understand if I'm the PI of a project that will have many users from other institutions, I will:

A) Provide a list of users who will request access to the REDCap team

B) Provide training for these users, and will inform the REDCap team how I am training these users.

C) Assign user rights to the new users and remove them after they are no longer with the project or work at CNMC or GW.

* must provide value

Yes

If my project for which REDCap will be used involves human subjects research, it has been submitted to the Institutional Review Board (IRB) for review or exemption and has been APPROVED before the project will be moved to production and data collection can commence. Additionally, I will input the IRB number and study information into the Main Project Settings information.

* must provide value

Yes

I will not share my password with others and will not allow others to use my REDCap account.

* must provide value

Yes

When I leave GW or CNMC or a project affiliated with either institution, I will notify the REDCap Help Desk or project PI so that they may remove me as a user.

* must provide value

Yes

I need full access and I have met ONE of the following requirements:

a. Attended the in campus hands-on training session REDCap 101, below is the link for sign up and training dates: N/A

OR

b. Completed REDCap 101 Online Training.

***Later in the form, you will be asked to provide specifics on the nature of your REDCap training.

Yes

I am aware that if my account has been inactive for 1 year (365 days), and I have not responded to the email to confirm that I'm still using REDCap, my user name and password will be suspended.

* must provide value

Yes

If I am sending a survey out to more than 100 respondents, I will email the REDCap team for approval prior to sending out the survey.

* must provide value

Yes

I will cite the publication below in study manuscripts using REDCap for data collection and management.

We recommend the following boilerplate language:

Study data were collected and managed using REDCap electronic data capture tools hosted at George Washington University.1 REDCap (Research Electronic Data Capture) is a secure, web-based application designed to support data capture for research studies, providing 1) an intuitive interface for validated data entry; 2) audit trails for tracking data manipulation and export procedures; 3) automated export procedures for seamless data downloads to common statistical packages, and 4) procedures for importing data from external sources.

1 Paul A. Harris, Robert Taylor, Robert Thielke, Jonathon Payne, Nathaniel Gonzalez, Jose G. Conde, Research electronic data capture (REDCap) - A metadata-driven methodology and workflow process for providing translational research informatics support, J Biomed Inform. 2009 Apr;42(2):377-81.

* must provide value

Yes

Last Name

* must provide value

First Name

* must provide value

GW or CNMC Email:

If you do not have a CNMC or GW email, please fill out your work email address and make sure to name the PI/study chair below who is affiliated with CNMC or GW.

* must provide value

Do you have an ORCID ID?

Yes

reset

If "Yes," please provide it here.

(OPTIONAL) If "No," please create an ORCID ID by visiting: https://orcid.org/register and return to the above question.

User's organization:

* must provide value

Children's National Hospital

George Washington University

George Washington Hospital

Other

reset

What is your NetID/UserID?

* must provide value

If other organization/institution, please provide

* must provide value

Children's National Hospital Department/Location:

* must provide value

Children's Research Institute

Sheikh Zayed Institute for Pediatric Surgical Innovation

Children's National Hospital

Other

reset

CRI Center Name:

* must provide value

Center for Cancer and Immunology Research

Center for Clinical and Community Research

Center for Genetic Medicine Research

Center for Molecular Physiology Research

Center for Neuroscience Research

Other

reset

If other CRI center, please specify

* must provide value

Sheikh Zayed Institute Initiatives:

* must provide value

Pain medicine

Bioengineering

Immunology

Systems Biology

Other

reset

If other Sheikh Zayed institute, please specify

* must provide value

Division:

* must provide value

If other department/location, please specify

* must provide value

GW School:

* must provide value

MISPH

SMHS

MFA

SEAS

School of Nursing

Other

reset

If other school, please specify

* must provide value

GW MISPH Department:

* must provide value

Environmental and Occupational Health

Epidemiology and Biostatistics

Exercise and Nutrition Sciences

Global Health

Health Policy

Health Services Management and Leadership

Prevention and Community Health

Other

reset

If other GW MISPH department, please specify

* must provide value

Assignment:

* must provide value

Faculty

Staff

Student

Intern

External Collaborator

Other

reset

Job Title:

* must provide value

What is your affiliation/organization?

* must provide value

If other assignment, please specify

* must provide value

When is the anticipated graduation date?

* must provide value

M-D-Y

When will the internship end?

* must provide value

M-D-Y

PI Name for your project or study chair:

(This person should be affiliated with GW or CNMC)

PI's Email:

Role in the project:
(Check all that apply)

Co-Investigator

Assistant Coordinator

Clinical Research Assistant

Data Analyst

Data Collector/Data Entry specialist

Database Specialist

Graduate Research Assistant

Manager/Coordinator

Mentor

Research Associate

Research Coordinator

Research Fellow

Research Intern

Research Nurse

Volunteer

Other

Please specify other role:

* must provide value

Please specify the training you completed:

* must provide value

REDCap101 online (GWU)

Tutorial review, FAQ review and test taking (deprecated)

Other

None

Please provide the best date for when REDCap101 training was completed:

M-D-Y

If other training, please specify

OPTIONAL: If none, please register for GWU's REDCap training here before submitting this survey.

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.