+-------+--------+-------------------+---+--------+--------+--------+
| Prin  |        |                   |   |        |        |        |
| cipal |        |                   |   |        |        |        |
| Inves |        |                   |   |        |        |        |
| tigat |        |                   |   |        |        |        |
| or/Pr |        |                   |   |        |        |        |
| ogram |        |                   |   |        |        |        |
| Dir   |        |                   |   |        |        |        |
| ector |        |                   |   |        |        |        |
| (     |        |                   |   |        |        |        |
| Last, |        |                   |   |        |        |        |
| F     |        |                   |   |        |        |        |
| irst, |        |                   |   |        |        |        |
| Mid   |        |                   |   |        |        |        |
| dle): |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
|       |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
| #     |        |                   |   |        |        |        |
| # Tar |        |                   |   |        |        |        |
| geted |        |                   |   |        |        |        |
| /Plan |        |                   |   |        |        |        |
| ned E |        |                   |   |        |        |        |
| nroll |        |                   |   |        |        |        |
| ment  |        |                   |   |        |        |        |
| Table |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
| # Th  |        |                   |   |        |        |        |
| is re |        |                   |   |        |        |        |
| port  |        |                   |   |        |        |        |
| forma |        |                   |   |        |        |        |
| t sho |        |                   |   |        |        |        |
| uld N |        |                   |   |        |        |        |
| OT be |        |                   |   |        |        |        |
|  used |        |                   |   |        |        |        |
|  for  |        |                   |   |        |        |        |
| data  |        |                   |   |        |        |        |
| colle |        |                   |   |        |        |        |
| ction |        |                   |   |        |        |        |
|  from |        |                   |   |        |        |        |
|  stud |        |                   |   |        |        |        |
| y par |        |                   |   |        |        |        |
| ticip |        |                   |   |        |        |        |
| ants. |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
| Study |        |                   |   |        |        |        |
| T     |        |                   |   |        |        |        |
| itle: |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
| Total |        |                   |   |        |        |        |
| Pl    |        |                   |   |        |        |        |
| anned |        |                   |   |        |        |        |
| E     |        |                   |   |        |        |        |
| nroll |        |                   |   |        |        |        |
| ment: |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
|       |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
| T     |        |                   |   |        |        |        |
| ARGET |        |                   |   |        |        |        |
| ED/PL |        |                   |   |        |        |        |
| ANNED |        |                   |   |        |        |        |
| E     |        |                   |   |        |        |        |
| NROLL |        |                   |   |        |        |        |
| MENT: |        |                   |   |        |        |        |
| N     |        |                   |   |        |        |        |
| umber |        |                   |   |        |        |        |
| of    |        |                   |   |        |        |        |
| Sub   |        |                   |   |        |        |        |
| jects |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
| E     |        |                   |   | Sex/   |        |        |
| thnic |        |                   |   | Gender |        |        |
| Cat   |        |                   |   |        |        |        |
| egory |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
|       |        |                   |   | F      | Males  | Total  |
|       |        |                   |   | emales |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
| His   |        |                   |   |        |        |        |
| panic |        |                   |   |        |        |        |
| or    |        |                   |   |        |        |        |
| L     |        |                   |   |        |        |        |
| atino |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
| Not   |        |                   |   |        |        |        |
| His   |        |                   |   |        |        |        |
| panic |        |                   |   |        |        |        |
| or    |        |                   |   |        |        |        |
| L     |        |                   |   |        |        |        |
| atino |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
| E     |        |                   |   |        |        |        |
| thnic |        |                   |   |        |        |        |
| Cate  |        |                   |   |        |        |        |
| gory: |        |                   |   |        |        |        |
| Total |        |                   |   |        |        |        |
| of    |        |                   |   |        |        |        |
| All   |        |                   |   |        |        |        |
| Sub   |        |                   |   |        |        |        |
| jects |        |                   |   |        |        |        |
| \*    |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
| R     |        |                   |   |        |        |        |
| acial |        |                   |   |        |        |        |
| Categ |        |                   |   |        |        |        |
| ories |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
| Ame   |        |                   |   |        |        |        |
| rican |        |                   |   |        |        |        |
| Ind   |        |                   |   |        |        |        |
| ian/A |        |                   |   |        |        |        |
| laska |        |                   |   |        |        |        |
| N     |        |                   |   |        |        |        |
| ative |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
| Asian |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
| N     |        |                   |   |        |        |        |
| ative |        |                   |   |        |        |        |
| Haw   |        |                   |   |        |        |        |
| aiian |        |                   |   |        |        |        |
| or    |        |                   |   |        |        |        |
| Other |        |                   |   |        |        |        |
| Pa    |        |                   |   |        |        |        |
| cific |        |                   |   |        |        |        |
| Isl   |        |                   |   |        |        |        |
| ander |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
| Black |        |                   |   |        |        |        |
| or    |        |                   |   |        |        |        |
| Af    |        |                   |   |        |        |        |
| rican |        |                   |   |        |        |        |
| Ame   |        |                   |   |        |        |        |
| rican |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
| White |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
| R     |        |                   |   |        |        |        |
| acial |        |                   |   |        |        |        |
| C     |        |                   |   |        |        |        |
| atego |        |                   |   |        |        |        |
| ries: |        |                   |   |        |        |        |
| Total |        |                   |   |        |        |        |
| of    |        |                   |   |        |        |        |
| All   |        |                   |   |        |        |        |
| Sub   |        |                   |   |        |        |        |
| jects |        |                   |   |        |        |        |
| \*    |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+
| \*    |        |                   |   |        |        |        |
| The   |        |                   |   |        |        |        |
| "E    |        |                   |   |        |        |        |
| thnic |        |                   |   |        |        |        |
| Cate  |        |                   |   |        |        |        |
| gory: |        |                   |   |        |        |        |
| Total |        |                   |   |        |        |        |
| of    |        |                   |   |        |        |        |
| All   |        |                   |   |        |        |        |
| Subj  |        |                   |   |        |        |        |
| ects" |        |                   |   |        |        |        |
| must  |        |                   |   |        |        |        |
| be    |        |                   |   |        |        |        |
| equal |        |                   |   |        |        |        |
| to    |        |                   |   |        |        |        |
| the   |        |                   |   |        |        |        |
| "R    |        |                   |   |        |        |        |
| acial |        |                   |   |        |        |        |
| C     |        |                   |   |        |        |        |
| atego |        |                   |   |        |        |        |
| ries: |        |                   |   |        |        |        |
| Total |        |                   |   |        |        |        |
| of    |        |                   |   |        |        |        |
| All   |        |                   |   |        |        |        |
| Subje |        |                   |   |        |        |        |
| cts." |        |                   |   |        |        |        |
+-------+--------+-------------------+---+--------+--------+--------+

PHS 398/2590 (Rev. 05/01) Page [   ]{.underline} **Targeted/Planned
Enrollment Format Page**