Cumulative Inclusion Enrollment Report - Sample Grant-gov 2

Cumulative Inclusion Enrollment Report OMB Number: 0925-0001/0002

This report format should NOT be used for collecting data from study participants.

Study Title:

Comments:

Racial Categories	Ethnic Categories									Total
	Not Hispanic or Latino			Hispanic or Latino			Unknown/Not Reported Ethnicity
	Female	Male	Unknown/Not Reported	Female	Male	Unknown/ Not Reported	Female	Male	Unknown/Not Reported
American Indian/ Alaska Native	0	0	0	0	0	0	0	0	0	0
Asian	0	0	0	0	0	0	0	0	0	0
Native Hawaiian or Other Pacific Islander	0	0	0	0	0	0	0	0	0	0
Black or African American	0	0	0	0	0	0	0	0	0	0
White	0	0	0	0	0	0	0	0	0	0
More Than One Race	0	0	0	0	0	0	0	0	0	0
Unknown or Not Reported	0	0	0	0	0	0	0	0	0	0
Total	0	0	0	0	0	0	0	0	0	0

DELETE STUDY NEXT STUDY

To ensure proper performance, please save frequently.