Protocol Review Committee Retrospective Study Application
All information on this form is required. Submissions which do not include the required documentation will not be processed or added to an agenda until all required documentation is provided.
Does this retrospective study/chart review involve cancer?
Cancer Institute Protocol Review Committee review is not needed for non-cancer studies. You
need to submit this form.
Does this protocol involve only the analysis of pre-existing data?
Studies that involve more than the use of pre-existing data should complete the Protocol Review Committee full new study submission form (email
for that form).
submit this form.
Study team information
Principal Investigator First Name
Principal Investigator Last Name
Principal Investigator Email
Sub-Investigators at Penn State Cancer Institute
Is the person submitting this form the PI?
Submitter First Name
Submitter Last Name
Upload full protocol ("clean" version)
(.doc, .docx or .pdf file only)
What is the primary disease team leading this study?
Benign Hematology/Bone Marrow Transplant/Hematological Malignancies
Head and Neck Cancer
What disease team is involved with this study?
Include any helpful information the PI feels would be integral to the review of this retrospective study by the PRC.
Your submission of this form indicates that the Principal Investigator named herein is aware of the information provided and serves in lieu of their signature.