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Forms
AVAILABLE FORMS

Phase I, II, I/II, and III studies' forms are available on-line. Please contact Randomization at (215) 574-3191 to request other forms packets.
The following studies' forms are now available in PDF (Adobe Acrobat) format:

  1. 0822 Phase II Rectal
  2. 0630 Phase III Sarcoma
  3. 0627 Phase II GBM
  4. 0625 Phase II GBM
  5. 0623 Phase II SCLC
  6. 0622 Phase II Prostate Samarium
  7. 0621 Phase II Prostate
  8. 0618 Phase II SBRT
  9. 0617 Phase III NSCLC
  10. 0615 Phase II Nasopharyngeal
  11. 0614 Phase III Memantine/Placebo/WBRT
  12. 0611 GBM VEGF/MMP
  13. 0534 Phase III Prostate
  14. 0529 Phase II Anal Canal
  15. 0526 Phase II Prostate Brachy
  16. 0525 Phase III GBM
  17. 0524 Chemo/XRT for Non-cystectomy Bladder Cancer
  18. 0522 Advanced H & N
  19. 0521 Phase III study of Localized High Risk Prostate Cancer
  20. 0518 Phase III Prevent Osteo
  21. 0517 Palliation Bone Mets
  22. 0515 NSCLC
  23. 0514 Head and Neck Tissue/Specimen Bank
  24. 0513 Phase I/II GBM
  25. 0438 Phase I RT Unresectable Liver Mets
  26. 0436 Phase III Esophagus
  27. 0435 H & N/Palifermin
  28. 0424 Phase II Brain Chemoradiation for High Risk Low Grade Glioma
  29. 0421 Phase III Recurrent Head and Neck
  30. 0420 Phase II GBM RT & TMZ Followed by TMZ & Irinotecan
  31. 0418 Phase II IMRT
  32. 0417 Phase II Cervix/Bevacizumab
  33. 0415 Phase III Prostate
  34. 0412 Phase III Lung
  35. 0411 Phase II Advanced Pancreas
  36. 0330 Phase II Sarcoma
  37. 0324 Phase II Lung: Cetuximab with Chemoradiation
  38. 0321 Phase II Prostate Cancer
  39. 0320 Phase III Multiple Brain Metastases
  40. 0319 Phase I/II Breast 3D CRT
  41. 0315 Phase III Sandostatin
  42. 0247 Phase II Rectal
  43. 0246 Phase II Esophagus
  44. 0244 Head & Neck Phase II Salivary
  45. 0241 Phase I Lung
  46. 0239 Phase II Lung
  47. 0236 Inoperable Stage I/II NSCLC
  48. 0234 Phase II
  49. 0233 Bladder/Chemotherapy + RT
  50. 0232 Phase III Prostate
  51. 0229 Phase II Lung
  52. 0227 Phase I/II CNS Lymphoma
  53. 0225 Phase II Nasopharyngeal IMRT/Chemotherapy
  54. 0215 Prostate
  55. 0214 Lung Prophylactic Cranial RT
  56. 0213 Phase I/II Lung
  57. 0212 Lung Prophylactic Cranial RT
  58. 0211 GBM - RT & Iressa (ZD1839)
  59. 0132 Gleevec (STI-571)/Gist
  60. 0131 Pre-Irradiation & Concurrent Temozolomide Anaplastic Oligodendrogliomas & Mixed Anaplastic Oligoastrocytomas
  61. H-0129 Head and Neck
  62. 0128 Phase II Cervix: RT + Chemotherapy, (+) Celebrex
  63. P-0126 Prostate
  64. 0124 Retroperitoneal Sarcoma
  65. 0123 Phase II Lung
  66. 0122 Cancer Cachexia
  67. 0119 Phase II Melatonin for Brain Metastasis
  68. BR-0118 Multiple Brain Metastases
  69. 0117 Phase I/II Lung: 3D-CRT/Chemo
  70. 0116 Phase I/II Cervix: RT + Chemotherapy
  71. 0114 GastricPost-Op Chemo/RT
  72. 0113 Phase II Esophagus / Chemoradiotherapy
  73. 0024 Phase II Post-Op Head & Neck
  74. 0023 GBM-EBXRT & SRT
  75. 0022 Phase I/II Head and Neck IMRT
  76. 0020 Locally Advanced Pancreas
  77. 0019 Phase II Prostate Implant
  78. 0017 Phase I Lung
  79. P-0014 Prostate
  80. 0013 Phase II GBM/Bleomycin
  81. 0012 Phase II Rectal Study
  82. P-0011 Prostate
  83. 9913 Head and Neck
  84. 9911 Recurrent Head & Neck
  85. 9910 Prostate
  86. 9909 Post Op Immunotherapy/RT
  87. 9905 Endometrium
  88. 9904 Gastric
  89. 9903 Head and Neck
  90. 9902 Prostate
  91. 9901 Head and Neck
  92. 9813 Anaplastic Astrocytoma
  93. 9811 Anal Canal
  94. 9809 GI Sequelae/PPS
  95. 9804 Breast DCIS
  96. 9803 Phase I/II 3D GBM
  97. 9802 Low Grade Glioma
  98. 9801 Lung/Amifostine
  99. 9714 Bone Metastases
  100. 9704 Pancreas
  101. 9601 Prostatectomy
  102. 9512 T2 Vocal Cord
  103. 9413 Phase III Prostate
  104. 9408 Phase III Prostate
  105. 9406 Prostate 3D-CRT
  106. 9202 Phase III Prostate
  107. 8531 Phase III Prostate


NON-STUDY SPECIFIC FORMS

The following non-study specific forms are available:

Miscellaneous

  1. Adverse Event Expedited Reporting System (AdEERS)
  2. FDA Form 1572 - Statement of Investigator [PDF]
  3. General Communication Memo [PDF]
  4. Label Request [PDF]
  5. Request for Change in Primary Research Associate [PDF]
  6. Patient Transfer Form [DOC]
  7. Intergroup Case Credit Form [PDF]
  8. Calendar Request [PDF]
  9. Pill Diary Template [PDF]

Pathology

  1. Specimen Transmittal Form [PDF]

Regulatory

  1. 310 Form for IRB approvals. [PDF]

Withdrawal of Consent

  1. Instructions [PDF]
  2. Form [PDF]

International Site Participation

  1. Exhibit D - Logistical Issues & Letter of Intent [doc]
  2. International REC Certification [doc]