Research Group Members Research Group Members

If you are a DPPOS Study staff or research group member and would like to access to the secure DPPOS Group website, please (1) complete the sign-up form below and (2) ask your clinic's program coordinator to email the Coordinating Center to confirm your request. Once both the form is complete and your request is confirmed by a PC, a CoC staff member will contact you regarding your new account.

Alternatively, please complete the website request form and email your request to the Coordinating Center.

Website Access Request Form Website Access Request Form

First Name (Required)

Last Name (Required)

Desired Username (Required)

DPPOS Affiliation (Required)

If "other," Institution/Affiliation

Position within DPPOS (Required)

Email Address (Required)

Address

Phone Number

Fax Number

Additional email addresses

Degrees

Name for Publications

Are you listed on local IRB application to work on DPP/OS?

Yes

Unsure

I promise not to divulge any study data and information to non-authorized people. I will not use the web site information for non-study purposes. I will keep my screen name and password confidential and will not let anyone else use it (all presentations of study data must be approved by the Publications and Presentations Subcommittee). In the event that I am no longer involved in the study, I understand that I will no longer attempt to access the study web site. Sign electronic signature or initials to confirm your agreement.

Additional Comments

[For CoC Use Only] Date account created