Advancing new research

Application process

Application form

*required fields

Reference number (from invitation) *
Reference number is required
Name of principal investigator *
Investigator name is required
Full contact information of principal investigator, including institution and street address *
Contact information is required Please limit to 400 characters
Telephone number *
Telephone number is required
Fax number
E-mail address *
E-mail address is required A valid E-mail address is required
Names of sub-investigators (if applicable)
	Please limit to 400 characters
E-mail addresses of sub-investigators (if applicable)
Please limit to 400 characters
Institution where proposed research will be conducted *
Institution is required
Official Signing for applicant organization
Name:* Name is required Title: Telephone: Fax: E-mail: * E-mail address is required A valid E-mail address is required
Title of proposed research *
Title is required
Type of study:*
Please Choose Clinical Observational Clinical Interventional Non-Clinical Selection is required
Primary aim of study *
Primary aim is required
Secondary aim(s) of study
Please limit to 400 characters
Primary end point *
Primary endpoint is required
Secondary end point(s)
Please limit to 400 characters
Number of study subjects/animals
Sample size rationale *
Rationale is required Please limit to 400 characters
Please attach your curriculum vitae (Word or PDF format). *
Curriculum vitae is required Upload Word or PDF documents only.
Please attach your research protocol (Word or PDF format). * The protocol must use the standard CSL Behring template, which can be downloaded using this link. Protocol must include itemized budget in US dollars and timeline.
Protocol is required Upload Word or PDF documents only.
Estimated funding requirement in US Dollars (including salary, overhead and direct costs, but excluding product) *
Estimated funding is required
Estimated contribution (%) to funding requirement from:
Salary:* Required Overhead: * (not to exceed 35%) Required Direct Costs: * Required
Please select study drug*
Please Choose None Privigen Hizentra Privigen and Hizentra Selection is required
Total amount of Privigen (in Grams) required for entire study:* Required Please enter a number only
Total amount of Hizentra (in Grams) required for entire study:* Required Please enter a number only
Will your study involve the use of placebo?*
Please Choose Yes No Selection is required
If your study involves placebo, please describe what will be used as the placebo and who will be responsible for bottling it and maintaining blinded conditions. (CSL Behring will not supply placebo.) Please limit to 2000 characters Do you have the necessary knowledge, experience, and resources to manufacture and blind this placebo in full compliance with all applicable laws and regulations?* Please Choose Yes No Selection is required If this will be delegated, please indicate the responsible person Please describe in detail (if applicable) your plan for dispensing blinded drug/placebo at all sites involved in the study, and for maintaining blinding. Please limit to 2000 characters
Please describe (if applicable) the blinding methods that you plan to use.
Please limit to 2000 characters
Project duration (Months) *
Project duration is required Please enter a number only
Start date *
Start date is required
End date *
End date is required
Anticipated plan for presenting and publishing data
Meeting abstract / poster (please specify)  Journal article (please specify)  Other (please specify)
Please attach any required official approval for application submission from an authorized official at your institution (Word or PDF format). *
Approval evidence is required Upload Word or PDF documents only.
Please describe any independent funding that will be sought, if any, from governmental or any other agencies, to supplement funding of this study *
Description is required Please limit to 2000 characters
Please briefly describe the facilities that you will be using to conduct this study, including their capacity, proximity, and availability, including the level of support or any specific expertise/effort from collaborators and/or from your institution*
Description is required Please limit to 2000 characters
If your trial involves human subjects, will it be conducted in a dedicated clinical research unit?*
Please Choose Yes No Study does not involve human subjects Selection is required
For trial involving human subjects, do you have an experienced research/study coordinator?*
Please Choose Yes No Study does not involve human subjects Selection is required
Please provide the coordinator's name * Required
For trial involving human subjects, have you previously submitted (as the Principal Investigator) a study proposal and consent forms to an IRB/ethics committee, or do you have a coordinator who will do this?*
Please Choose Yes No Study does not involve human subjects Selection is required
If your study involves animals, have you previously submitted (as the Principal Investigator) an animal care and use protocol to your appropriate institutional committee(s)?*
Please Choose Yes No Study does not involve animals Selection is required
Do you have a research pharmacy capable of properly storing and tracking study drug (and placebo if required)?*
Please Choose Yes No Selection is required
If your project involves high capacity computing and/or sequencing, please describe in detail where and how this will be accomplished, and be sure all costs are included in the budget.
Please limit to 2000 characters
Does your study involve multiple sites?*
Please Choose Yes No Selection is required
If your study will involve multiple sites, please indicate the number of sites, describe the investigators, the facilities and scientific environment at the other sites. Please limit to 2000 characters
I certify that I have the necessary qualifications, skills, and experience to conduct this study as it is being proposed. I also certify that I will have the necessary resources to conduct this study as it is being proposed, including (but not necessarily limited to) personnel, institution, and equipment. Certification is required
Please indicate that you acknowledge and consent to the following: *
“I understand that my submission will be reviewed by an internal committee at CSL Behring, and that if the committee decides not to fund the project at any step in the review process, the information in the submission will be destroyed confidentially by CSL Behring and no further use of the submission will be made by CSL Behring. I certify that the statements herein are true, complete, and accurate to the best of my knowledge.”
I have read and agree to these conditions. Agreement is required