Abstract/Case Study Submission Form

	15th Annual Carilion Clinic/Virginia Tech Carilion 2022 Research Day
	April 5, 2022
	Virtual Format via Webex

Abstract/Case Study Submission Form

	Abstract/Case Study Submission Instructions and Example	Assistance/Questions
	(Thoroughly read instructions before completing this form)	Email - Research@carilionclinic.org

* Indicates required field

Select Project/Study Type*

Applied or QA/QI

Basic

Clinical

Translational

Select Abstract Type*

Completed Project

Case Study

Work in Progress

Select First Author Listed Status*

Faculty/Professional

Resident/Fellow

Student*

Consider for Rapid Communication Presentation?*

Yes

Provide at least three (3) and no more than ten (10) keywords that describe the research.

Keyword
No Keywords Added

This online submission form will ONLY accept characters and symbols found on a STANDARD keyboard. Special characters/scientific symbols WILL NOT translate.

Title:*
(NO MORE THAN 10 WORDS)

First Author:*

First Name*	Last Name*	Middle Initial	Credentials*	Email Address*

Affiliation*			Department*

Additional Authors:

First Name	Last Name	Middle Initial	Credentials	Affiliation	Department

After entering an additional author's information in the text boxes above you must click the 'Add' button to the right to add the additional author to the table below. The additional author's information will then be included in your abstract/case study submission form.

First Name	Last Name	Middle	Credentials	Affiliation	Department
No Additional Authors Added

Abstract/Case Study:*