Applicant 

Full name applicant

Organisation applicant

Organisation type applicant Academic Non-Profit Commercial

Position applicant

Academic title applicant

Department applicant

Address applicant

Country applicant

Institutional email address applicant

ORCID applicant

Principal investigator

Full name principal investigator

Organisation principal investigator

Organisation type principal investigator Academic Non-Profit Commercial

Academic title principal investigator

Address principal investigator

Country principal investigator

Institutional email address principal investigator

Phone number principal investigator

ORCID principal investigator

Participating researcher

Full name participating researcher

Organisation participating researcher

Organisation type participating researcher Academic Non-Profit Commercial

Academic title participating researcher

Country participating researcher

Institutional email address participating researcher

ORCID participating researcher

Please state all researchers and affiliations, including consortium members and collaborators, who will have access to the data. If there are more participating researchers, please file the attached document below this form and upload it. 

In case of more participating researchers Voeg een bijlage toe max. 5MB

Description of requested data

Requested data: specify URL or DOI of dataset

Research context 

Briefly describe the context for your project (maximum 200 words).

Project title

Short project summary

Background

Research question

Please describe how the requested data specifically contributes to addressing your research question

Hypotheses

Please provide your research hypotheses. For each hypothesis: Be as specific as possible and provide the anticipated outcomes for accepting and/or rejecting the hypothesis.

Statistical methods

Please state the statistical methods you are applying during your project:

- What is  the sample size for your project (include a sample size calculation, or explanation of why you do not include a sample size calculation)?

- What statistics measures will you use?

- What is the study design and study population? (which data do you require from which subjects?)

Methods

Remarks 

Do you have any questions or remarks?

Declaration: (Please tick this box) I hereby declare that the information provided in this data request form is true and correct. I understand that this data request form, including revisions and/or restrictions imposed by the Data Access Committee, is part of the final, legal agreement.

Declaration: (Please tick this box) I agree that my personal data and the information in this form are processed by UMC Utrecht to handle my request. The privacy statement of UMC Utrecht is applicable to this processing.