DoI Intake Form — Concept Mockup

A

General InformationAlways shown

Project Title *

Project Acronym optional

Role of LIH *

Application Type / Activity Type *

Research Project

Clinical Research

Interinstitutional Translational Project

Doctoral Training

Public Private Partnership

Fee-for-Service

Mission & Mandate for Gov./Ministries

Scientific Event or Dissemination

Networking

Other

Includes Clinical Study * shown if Activity Type contains "Clinical Research"

National Study Sites optional

LIH

UL

CHL

HRS

CHEM

CHdN

LRC-Support auto-computed

Non-eligible

B

Project DescriptionAlways shown

Project Start Date *

Project Duration (months) *

Project Start Rationale optional

Question / Problem / Study Summary *

0/300

Objectives optional

0/500

Contribution (Own Contribution / Role) *

0/500

Impact (Expected Impact / Value) optional

0/300

C

Main ApplicantAlways shown

D

PartnersAlways shown · repeatable

E

FundingShown if Role of LIH = Coordinator / Partner

conditional

Funder *

Fund Type optional

Funding Instrument optional

External Submission Deadline optional Past dates allowed — consider an SLA reminder rule.

Total Requested Funding optional

kEUR

LIH Requested Funding *

kEUR

LIH Planned Budget *

kEUR

Complementary Funding Strategy *

0/500

F

Staff / ResourcesAlways shown

Position	Time (PM)	Funding source	Comment

Resource	Budget (kEUR)	Funding source	Comment

Total PhDs at Project Runtime (max 4/PI) shown if Role of LIH = Coordinator / Partner AND a Staff Position = PhD Student

Comment * required if ≥ 4

G

Special NeedsShown if Role of LIH = Coordinator / Partner

conditional

H

General Study InformationShown if Includes Clinical Study = Yes

conditional

Study Status *

Project Manager shown if Status ∈ {Design-Setup, Initiation, Operations}

Regulatory & Ethical Approval *

LRC Pillar *

Disease Area *

Sponsor *

Sponsor Contact Person optional

I

Operational Study InformationShown if Includes Clinical Study = Yes

conditional

Study Design *

Study Structure *

Study Participants optional

Total Duration (months) *

Recruitment Period *

to

Follow-up Period optional

Recruitment Rationale optional

Collected Data Types *

Collected Sample Types *

National Recruitment Target *

National Recruitment to Date optional

Comment optional

Global Recruitment Target optional

Global Recruitment to Date optional

Comment optional

Declaration of Intent — New Submission

Sections

General InformationAlways shown

Project DescriptionAlways shown

Main ApplicantAlways shown

PartnersAlways shown · repeatable

FundingShown if Role of LIH = Coordinator / Partner

Staff / ResourcesAlways shown

Special NeedsShown if Role of LIH = Coordinator / Partner

General Study InformationShown if Includes Clinical Study = Yes

Operational Study InformationShown if Includes Clinical Study = Yes