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Supported Research Application Form

If you are interested in applying for product support for your research project, please complete the form below. Only electronic submissions via this webpage are accepted. Please read our research policy before filling out this form. We will reply in approximately 2 weeks. If you do not receive a reply by then, contact us.

ALL RESEARCHERS MUST FIRST BE REGISTERED WITH THE ACADEMY. Login or create your profile here.

Title of Project:		*
Primary Investigator:		*
Institution:		*
Email:		*
Phone Number:

Primary Contact:		*
Contact Email:		*
Contact Phone Number:		*
Faculty Advisor:
Faculty Advisor Email:

Street Address (No PO Boxes):		*
City:		*
State:		*
Postal Code:		*
Country:		*

Type of Study:		*
Study Design:		*
Non-technical Abstract (250 words) Include significance, purpose, methods, and specific use of Thera-Band Products:		*
Specific Protocol including exercise prescription and progression with Thera-Band products Or Email the protocol to ppage(at)thera-band.com. Please reference you Project Title, Investigator Name, and Institution:		*
IRB Approval:		*
Thera-Band Resources Requested:		*

Today's Date:
Anticipated Start Date:	(mm/dd/yy) *
Anticipated Completion Date:	(mm/dd/yy) *
	I have read and understand the Thera-Band® Academy Research Policy, and I agree to the guidelines for supported research.

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