Office of Research Consultation Request

Organization*

Please, select your Stanford affiliation

First Name

Last Name

Work E-mail address

Phone Number

Phone

Department/ Unit/ Clinic

Manager/ Supervisor Name

Cost Center Number

If available

Position

Type of Consult Requested

Choose which option best fits your overall request. Your choice will determine how your consult will be routed.

Please briefly describe the reason for your consult

How did you learn about us?

Attended Research Primer

Attended Legacy Grant workshop

Attended drop-in office hours with Office of Research

New employee or general clinical orientation

Found information on the website

Nurse scientist encouraged me to submit a request

Department manager or leader

Other Stanford employee

None of the above

Are you the nurse scientist completing this form?*

Please indicate if you are the nurse scientist and completing this form on behalf of the person requesting the consultation.

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