The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

CDQeVQfIkBnIxZMgAhwex6dgBmmtkxKPV6K3yLpFBwwq9gEmEiS9pdogXzaTMRCx3TyrhXN4RIiyVbqjq7YM

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

* must provide value

Title

* must provide value

Institution

* must provide value

Email Address

* must provide value

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

* must provide value

Yes

reset

If yes, please specify.

Expand

Is this project funded?

* must provide value

Yes

reset

Is this request related to a grant proposal?

* must provide value

Yes

reset

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)

* must provide value

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

* must provide value

Project design or development

Study Implementation

Obtain Funding

Publication/Presentation

Other (Specify)

reset

If selected "Other", please specify.

* must provide value

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

* must provide value

Expand

Please describe the type of help you need:

* must provide value

Expand

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.

* must provide value

I agree to cite the IMPACT CORE

reset

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.