Clinical Trial Collaborative Agreement Form

1. Parties

Institution/Organization Name Collaborating Organization Name Principal Investigator Name Contact Information

2. Trial Information

Trial Title Protocol Number Trial Phase Phase I Phase II Phase III Phase IV Brief Description

3. Objectives and Scope

Objectives Scope of Collaboration

4. Roles & Responsibilities

Responsibilities of Institution Responsibilities of Collaborator

5. Financial Arrangements

Budget Summary Funding Source(s)

6. Intellectual Property & Publication

IP Arrangements Publication Rights

7. Confidentiality

Confidentiality Terms

8. Signatures

Authorized Representative of Institution Date Authorized Representative of Collaborator Date