WeP Project Agreement

WeP Project Name:(*)

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Principal Investigator

First Name:(*)

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Middle Name:

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Last Name:(*)

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E-mail:(*)

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Date of Birth

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Mailing Address

Country/Region:

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Company/Institution:

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Address Line 1:

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Address Line 2:

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Town/City:

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State/Province:

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Zip Code:

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Phone:

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Key word/Acronym (for data identification)

Identification code:(*)

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It is essential for data-retrieval to add this exact key word to the referral line as seen below in the preferred language, e.g. English or German.

Identification code de

Short description of project

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Instruments used on the WeP if not evident from the project flow The WeP is used as:

1. data entry service (scientists will enter the data)

2. semi-public instrument for subjects participating in the project described above (i.e., subjects receive a web address to fill out a WeP-based instrument, such as a questionnaire)

3. as stationary system in a clinic, lab, or exhibition setting where patients/subjects enter data (i.e., subjects come to a specific location and are asked to sit sown at one or more computers to fill out a WeP-based instrument, such as a questionnaire)

Estimated time frame of the project

Start

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Stop

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Estimated number of participants

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The Project has received official ethical approval

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The entered data will be part of the growing database but will not be used for any evaluation or publication of the specific cohort. The intellectual property of the cohort-specific data stays with the external WeP-user.

Data can be entered under

ENGLISH https://www.bioinfo.mpg.de/mctq/core_work_life/core/introduction.jsp?language=eng
GERMAN https://www.bioinfo.mpg.de/mctq/core_work_life/core/introduction.jsp?language=deu
FRENCH https://www.bioinfo.mpg.de/mctq/core_work_life/core/introduction.jsp?language=fr
DUTCH https://www.bioinfo.mpg.de/mctq/core_work_life/core/introduction.jsp?language=dut
SPANISH https://www.bioinfo.mpg.de/mctq/core_work_life/core/introduction.jsp?language=esp
PORTUGUESE (BRAZILIAN) https://www.bioinfo.mpg.de/mctq/core_work_life/core/introduction.jsp?language=por_b

Pricing

Units/Entries	(1-100)	(100-200)	(200-500)	(>500)
academic	€ 2,00	€ 1,00	€ 0,80	€ 0,50
non-academic	€ 20,00	€ 10,00	€ 8,00	€ 5,00

minimum price of € 100

Please choose your pricing

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Attachment

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only for Academic/Non-Profit Provide proof of your academic status

Comment

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NoAgreeInvalid Input

(*)

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