Academic Research Support Program

Existing Customer?

Are you an existing Cogstate customer?*

Name of existing study*

Name of Principal Investigator*

DataPoint URL Site (If applicable)

Is the new study replicating or building on a study previously using Cogstate?*

Yes
No

21 CFR Part 11 Compliance

If the data from your study is intended to be included in a US Food and Drug Administration (FDA) submission for the approval of a medication or medical device, then your study meets the criteria for 21 Code of Federal Regulation (CFR) Part 11 Compliance.

Please note, this also applies to FDA approved drugs being investigated as potential new treatments for unapproved or off-label indications.

Part 11, Electronic Records; Electronic Signatures - Scope and Application | FDA

Will the data generated from this study be submitted to the FDA or other regulatory agency as part of a drug or device approval process requiring 21 CFR Part 11 compliance?*

Yes
No

Study Details

Full Study Title*

Short Study Name*

The name of your study must be 2-16 characters long containing only Alpha and Numeric characters and dashes. Please note that no spaces are allowed between the characters.

Testing Environment

How will you be administering the battery?*

Hardware specifications*

The standard Cogstate Research product is designed for PC and is compatible with Windows XP, Vista, 7, 8, and 10 operating systems. PCs used for testing should have at least 10 GB hard disk drive (HDD), 1024 MB RAM, USB port, sound capability and a display with 1024 x 768 minimum resolution. No interfering software or browsers should be running during testing, and an internet connection is required for data uploading (or USB sticks can be used to transfer data to an internet connected computer for upload).

Participants

Participants will include members of the following age ranges*

Indicate the population group*

Expected Number of Subjects*

What is the main area of interest for the study?*

Select a category that best describes the general area of interest in the study.

Describe the specific indication/condition*

Describe the specific disease of interest in the study (i.e. Refractory Lymphoblastic Leukemia or Treatment-Resistant Major Depressive Disorder).

Testing Languages*

Select multiple languages if applicable

Additional language*

Additional languages can be added at an additional fee. Please list any additional languages needed.

Study Design

Start Date*

End Date*

What cognitive domains are you interested in measuring?*

Please refer to Tests of Multiple Cognitive Domains for examples: Academic Research | Cogstate | Cognitive Measurement

Cogstate Testing Sessions (estimated visit schedule)*

Describe the schedule of evaluations where cognitive testing will be conducted (i.e screening, baseline/enrollment, weekly treatment visits at weeks 1-10).

Is this study a drug intervention study?*

Yes
No

Is it a natural history study?*

Yes
No

Does your study need any additional support? (select multiple if needed)

General items

Statistical Analysis

Additional Information

Please provide a summary of the study and any other relevant information*

Additional tests can be provided at an additional fee via Custom Software Configuration.

Supporting Documents

Drop files here or

Max. file size: 50 MB.

Do you know which tests you would like to include in the battery?*

Yes
No

If yes, please select from the tests below*

Contact Details

Title*

Website

First Name*

Last Name*

Company/Institution*

Position*

Email Address*

Enter Email Confirm Email

Phone*

Name of principal investigator*

Mailing Address*

Mailing Address (Cont.)

City*

Country*

Zip*

State/Region*

State*

How did you hear about Cogstate?*

Terms of Use*

I have read and agree to the Terms of Use

This form collects personal information like your name and email so that we can process your research support request. Please review our Privacy Policy for details on how we protect and manage your submitted data.

Consent*

I consent to having Cogstate collect my personal information in accordance with their privacy policy.

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Email

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