Office of Clinical Research
1 Gustave L. Levy Place
Box 1120
New York, NY 10029
T. 212.824.7294
F. 212.824.2315
Clinical Trial Data Update Form for
New Trials and Updates
Submitted by (Name):
GCO# and/or HSM#:
Principal Investigator:
PI Department:
Title of Project:
Brief Lay Term Summary:
Currently Enrolling?
Project Contact Name:
Contact Telephone Number:
Contact Email Address:
Health Topic 1:
Health Topic 2 (if needed):
Choose one:
Choose one: