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Research Request

Medtronic Ear, Nose and Throat (ENT) Policy

Medtronic ENT funds research to advance scientific and clinical knowledge related to current or new therapies and products, in accordance with our strategic priorities and for the benefit of patients.

Medtronic ENT evaluates proposals based upon:

  • scientific soundness, quality and thoroughness of the proposal;
  • the business's research and budget priorities;
  • potential value to scientific or clinical knowledge; and
  • compliance with Medtronic ENT's Business Conduct Standards and the AdvaMed Code of Ethics.

Documentation
Medtronic ENT requires that the Request Form be complete and all supporting documents be submitted before review.

  • Scroll through this Request Form to understand the information and documents necessary for submission.
  • Complete and Submit the Form, making sure to attach all required supporting documentation.  (Read our FAQs)

Process

  1. The Medtronic ENT Research Coordinator will be your point of contact for any questions you may have. You will be notified if your submission is incomplete.
  2. All requests will be reviewed by the Medtronic ENT Research Donation Committee.
  3. It may take up to 90 days to review your request after receiving a complete request. This time frame allows Medtronic ENT to carefully review each request.

Please Note: If you leave this form idle for a period of 1 hour or more, the form will timeout and any information entered will be lost and you will need to re-enter it.

* Required Information

Researcher Information

*Name:

*Position/Title:

*Primary Institution:

*Street Address:

*City/State/Zip:

/ /

*Phone:

- -

Alternative Phone:

- -

Fax:

- -

*Email Address:

*How would you prefer to be contacted?

Phone Mail
E-mail Fax

   

Research Center Information

*Full Legal Name:

Same address as above

*Street Address:

*City/State/Zip:

/ /

*Institution Tax ID:

Payee Information (should request be granted)

Medtronic ENT requires that funds be paid to an Institution or Research Fund. Please indicate the payee name exactly as it should appear on the check:

*Payee Name:
   

Type of Proposal

* Please choose one of the following research types

Bench / Lab Testing

Animal Research

Human Research
   

Type of Support Requested

Funding
 

   * Please specify full amount in US dollars and cents:
   $

Medtronic ENT devices or specialized equipment
 

   * Please specify type of device(s) and quantity:
   

Other
 

   * Please specify:
   

* Are you requesting support from any other organization(s) or entity, including your own institution?

        No     Yes

* specify other organization(s):

* Have you already received funding for this project?

        No     Yes

* specify amount received:
$

   

Research Proposal

*1(a).

Title of Proposal:

*1(b).

Abstract. Please provide here a brief abstract of the research proposal:

*2(a).

Research Proposal. Please attach the research protocol, research plan, and/or other documentation describing the research in detail, including:
  • Hypothesis
  • Objectives
  • Proposed therapy
  • Rationale
  • Study design
  • Biostatistics and data analysis
  • Sample size and rationale
  • Significance to the scientific field
  • Significance to medtronic
  • Rationale for medtronic support
  • Schedule with key milestones
  • Protocol or study plan
choose method:

Attach file (you will be prompted to upload from the next page.)

Fax. To submit attachment by fax see point of contact for more information.

Email. To submit attachment by email, see point of contact for more information.

2(b).

Additional Documentation. As appropriate for the type of proposal, please attach additional documentation. This may include:
  • Estimate of applicable patient population
  • Inclusion and exclusion criteria
  • Clinical assessments
  • Animal model to be used or investigated
  • Previous relevant research conducted by you or others
choose method:

Attach file (you will be prompted to upload from the next page.)

Fax. To submit attachment by fax see point of contact for more information.

Email. To submit attachment by email, see point of contact for more information.

Not applicable.

*3.

Study Budget. Please attach a detailed study budget, choose method:

Attach file (you will be prompted to upload from the next page.)

Fax. To submit attachment by fax see point of contact for more information.

Email. To submit attachment by email, see point of contact for more information.

*4.

Curricula Vitae. Please attach a copy of the curriculum vitae of the principal investigator and other key researchers, choose method:

Attach file (you will be prompted to upload from the next page.)

Fax. To submit attachment by fax see point of contact for more information.

Email. To submit attachment by email, see point of contact for more information.

*5.

Additional Information:

   

IRB Information:

*Is IRB approval required?   Yes     No

*Does your institution have an IRB?

Yes     No

*Has your proposal been submitted to the IRB?

Yes     No

*Submission Date:

 / / Show Calendar

*Has your proposal been approved by the IRB?

Yes     No

*Approval Date:

 / / Show Calendar

In order to Review and Submit your research request click Continue.

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