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IMPACT Consultation Request Form

The Intervention Methodology: Provision and Connection Through Technology (IMPACT) Core of the REACH Center COBRE is designed to help facilitate research utilizing technology and innovative research methods in Delaware. To better assist you, please provide as much detail as you are able to provide about your project and needs. If your project is not fully formed, please enter as much preliminary information as you can provide. Your responses will help the IMPACT team determine how best to address your request.

A representative from IMPACT will respond to your request within one week.

Name

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Title

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Institution

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Email Address

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Is this request related to a REACH Center sponsored or proposed project?

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Yes

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If yes, please specify.

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Is this project funded?

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Yes

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Is this request related to a grant proposal?

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Yes

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Select the research method you believe you will use in your study. If you aren't sure which methods you will use, please select Uncertain. (You can select more than 1)

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Randomized Controlled Trial

Cohort Study

Time Series Study

Case-Control Study

Cross-Sectional Survey

Systematic Review/Meta Analysis

User-centered design

Focuses on developing or designing an intervention or program, typically in partnership with stakeholders

Pilot or feasibility testing

Small scale testing of an already-developed intervention or program

Uncertain

Please select a goal for your IMPACT request

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Project design or development

Study Implementation

Obtain Funding

Publication/Presentation

Other (Specify)

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Describe your methodology. Include what type of data you are collecting and what type of analyses you plan to perform on your data.

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Please describe the type of help you need:

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If there is a deadline or time by which we must complete this request (e.g., when a grant proposal is due), indicate that here, otherwise, you may leave this blank. We always address requests as quickly as possible, but do take submission deadlines into account.

Check the box below to agree that any journal article or technical report resulting from research using a REACH Center Core resource will cite the NIH grant as a contributing source of support. When publishing articles or reports related to this research, the following language is suggested:

This work is supported by the IMPACT CORE of the REACH COBRE funded by National Institute of General Medical Sciences of the NIH under grant number P20GM144270. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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I agree to cite the IMPACT CORE

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