APPLICATION MATERIALS

The resources in this section are provided to assist institutions with the process of initially
applying to participate in an ACRIN trial. They include application forms aimed at assessing
whether a minimum standard of quality exists at the applicant’s site. Other application materials
include forms that help establish the institution within the ACRIN automated data entry system
and questionnaires regarding the site’s qualifications to perform a specific imaging modality.
Links to existing materials are provided.

 

General Qualifying Application [DOC]
This "GQA" is necessary only for sites without a previously-approved site GQA on file at ACRIN
Headquarters. Sites listed on the ACRIN Participating Sites web page do not need to submit
this application. If you have questions about the GQA, contact ACRIN administration.
 
  

User Registration for Web-based Data Entry [External Link]

Every research staff person must have his or her own Login Name and Password or Reader ID (when applicable); ACRIN requires that the Login Name and Password or Reader ID issued not be shared.

Form FDA 1572 [DOC]
Form FDA 1572 must be submitted with a listing of study-specific site personnel; all
personnel listed on Form FDA 1572 must provide signed/dated CVs and proof of medical
license, as applicable.

NCI FAQs - Statement of Investigator (Form FDA 1572) [External Link]
This document includes instructions on appropriate completion of sections of the
Form FDA 1572.

ACRIN Statement of Investigator Form [PDF]
ACRIN-specific form acknowledging responsibilities and acceptance of duty as Principal
Investigator.

Sites participating in ACRIN clinical trials must either confirm ACR accreditation or  submit
a "quality assurance questionnaire" for the modality(ies) used in a specific clinical trial. 
The quality assurance questionnaire forms are listed below.

CT Quality Assurance Program Questionnaire [DOC]

MRI Quality Assurance Program Questionnaire [DOC]

Ultrasound Quality Assurance Program Questionnaire [DOC]

 

Protocol-specific applications for each protocol are available on the protocol-specific page. 
Go to the Protocol Summary Table section of this Web site and click on the protocol of interest.