Collaboration Interest Form

Please complete this form with as much detail as is possible. The information will be used to match your project with the most appropriate CORE collaborator.

Our team meets weekly to discuss all new projects. We will contact you as soon as we have received the completed form and our team has met to discuss your request.

All fields are required

Investigator Information

Full Name:

Department:

Work Phone:

Cell Phone:

E-mail:

Study Role:
Fellow
Resident (Must have chair's approval.)
Other

Project Information

Project Title:

Service Required: Please check all that apply

Study Design
Data Collection Strategies
Questionnaire Development
Sample Size
Statistical Plan
Analysis and Interpretation
Database Development
Faculty

Purpose:(Please check all that apply)
Meeting Abstract
Manuscript
Pilot Project
Extramural Funding Application (note source below)

Funding: (Please check all that apply)
Current funds available
Other funds available (Initial Consult first hour free, hourly fee of $75.00 for non grant funded projects.)
Non-funded
You may want to refer to RESEARCH DEVELOPMENT at Upstate for other funding sources.

Timeline

Please note: New Projects typically require 1 month's notice for adequate collaboration
Current status of project:

Any pertinent deadlines:

Description of request: (few lines of text)

Contact:

Ellen Jones
Office Manager
Office Phone: 315-464-4430
FAX: 315-464-4429