HAL request form

Questionnaire of interest HAL (>18 years) PedHAL (4-18 years)

Language Arabic (Emirates) Arabic (Egypt, Israel) Bengali Bulgarian Catalan Czech Chinese (simplified) Chinese (traditional) Croatian Danish Dutch English - for Australia English – for UK English – for USA and Canada Estonian Finnish Flemish French – for France French – for Canada Georgian German Greek Gujarati Hebrew Hindi Hungarian Indonesian (Bahasa) Irish Italian Japanese Kannada Korean Kurmanji Lettish Lituanian Malay Malayalam Marathi Norwegian Oriya (Odia) Polish Portugese – for Brazil Portugese – for Portugal Punjabi Romanian Russian Serbian Sesotho Slovak South African Spanish Spanish - for Latin America Swedish Tamil Telegu Thai Turkey Ukrainian Xhosa Zulu

Intended purpose of use Clinical use Investigator-initiated research (non-funded) Investigator-initiated research (funded) Sponsor-initiated research

Short description of the project

Name

Institution/company

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