Preclinical Investigator - Community Partnership Intake Form

Preclinical Investigator - Community Partnership Intake Form

Welcome, and thank you for your interest in engaging communities, patients, clinicians or other non-academic stakeholders in your research. The purpose of this form is to collect basic information about the study or project in which you would like to involve community or patient collaborators. Your responses enable our team to determine whether we can identify prospective partners and relevant training needs.

The purpose of this program is to facilitate development of user-centric design of new drugs, devices and diagnostics early in the development process by matching preclinical investigators with community, clinical or patient representatives who may one day be impacted by your work. We define "preclinical research" as any line of study that does not involve clinical care but is clearly translational to humans. Preclinical studies may involve human biospecimens, imaging or other diagnostic results, animal models and tissue cultures.

The duration of any matched preclinical-community research team is expected to be approximately 12 months, though teams may complete their scope of work earlier or decide to continue working together. Upon completion of this form, which should take 5-10 minutes, our team will review your responses and respond with any questions and next steps within a week or so. If you have any questions, please contact Sonia Bishop at skbishop@uw.edu.

Thanks, again for your interest in working with communities!

What is your first name?

What is your last name?

What are your pronouns?

What is your job title?

What is your email address?

What is your primary organization?

Where are you located?

Select or enter value

If you selected 'other' above, please indicate your state.

What is the title of your project or study?

Please include an abstract or summary about your project in the space provided or upload a file.

File Upload

Drag and drop files here or

Is your study funded?

Choose one.

Select or enter value

Timeline

Please provide any deadlines or describe in a sentence or two any time considerations.

Please describe the aspect of your research that may eventually relate to human health.

Consider how innovations emanating from your work on this study might impact human health, even if you do not intend on taking your research innovations to a clinical trial.

Please describe the community, patient, clinical or other stakeholder group that is most relevant to your project.

This community might be a specific patient population or minority group who will use your innovation or clinician or public health agency who will deploy it. If there is more than one group, please list them.

Have you worked with communities or other non-academic stakeholders before?

Choose one.

Select or enter value

Please provide a short description of this experience.

If you are matched with a community or patient advisor, what are your goals for this partnership?

Some examples might include better understanding of the patient experience with certain conditions, knowledge about therapeutic gaps experienced by patients, or insights into how patients or clinicians might use innovations emanating from my research.

Have you received training in community engagement before?

Select or enter value

Do you have specific training interests?

Do you have any questions you would like our team to address?

Send me a copy of my responses

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