Program Director/Principal Investigator (Last, First, Middle): |
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Targeted/Planned Enrollment Table |
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This report format should NOT be used for data collection from study participants. |
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Study Title: |
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Total Planned Enrollment: |
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TARGETED/PLANNED ENROLLMENT: Number of Subjects |
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Ethnic Category |
Sex/Gender |
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Females |
Males |
Total |
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Hispanic or Latino |
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Not Hispanic or Latino |
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Ethnic Category: Total of All Subjects * |
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Racial Categories |
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American Indian/Alaska Native |
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Asian |
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Native Hawaiian or Other Pacific Islander |
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Black or African American |
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White |
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Racial Categories: Total of All Subjects * |
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* The “Ethnic Category: Total of All Subjects” must be equal to the “Racial Categories: Total of All Subjects.” |
PHS 398/2590 (Rev. 09/07) Page Targeted/Planned Enrollment Format Page
File Type | application/msword |
File Title | PHS 398 (Rev. 9/07), Targeted/Planned Enrollment Table |
Subject | DHHS, Public Health Service Grant Application |
Author | Office of Extramural Programs |
Last Modified By | curriem |
File Modified | 2007-09-14 |
File Created | 2007-09-14 |