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Name of Applicant (Last, first, middle): |
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Targeted/Planned Enrollment TableThis 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 416-1/416-9 (Rev. 10/08) Page Targeted/Planned Enrollment Table Format Page
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Modified | 0000-00-00 |
File Created | 0000-00-00 |