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 North American 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:

8rtZS9S35s8P2vd3abxJJPDWWJ7HUysMe3mFX6FCGYTHrURsnuU9LzmrjoRvGahAnmhvTEjq6

KCIS COBRE Registration and Consultation Request Form

To register your project or request an initial consultation with the KCIS team please fill out the form below.

If you've already registered your project and would like a follow up consultation, reach out to the KCIS personnel that you'd like to meet with or contact Danny Kurz (dkurz@kumc.edu) if you aren't sure who to contact.

The option "" can only be selected by itself. Selecting this option will clear your previous selections for this checkbox field. Are you sure?

Registration Date:

* must provide value

M-D-Y

Name

* must provide value

Last Name (Alphabetization)

* must provide value

Phone Number

Department or Organization

* must provide value

Your Project's Name or Topic

* must provide value

Shortened project name/topic

(25 character max)

* must provide value

What type of research product are you requesting assistance with?

* must provide value

Internal grant application

External grant application

Manuscript or abstract

A study currently underway

General mentoring or career guidance

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What is the grant's funding mechanism

What is the grant application's deadline date?

What type of support are you seeking? (Check all that apply)

This will help us match you with the right core personnel.

* must provide value

Implementation science frameworks and methods

Implementation science biostatistics

Informatics or mHealth

Engagement with communities, clinics, or partners

Other

None of the above

Briefly describe your request, including project details and specific aims if available.
Please note any KCIS personnel already associated with this project.

* must provide value

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Is KCIS personnel registering this project?

* must provide value

Yes

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Is this a historical request (>21 days ago)?

If yes, the satisfaction survey won't be sent to the consult recipient, but a 1-year outcome survey will still trigger.

* must provide value

Yes

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Add additional information, notes, or comments about your request here.

If there are additional personnel who you would like to be included in the consultations, please include their name and email addresses here.

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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.