CASHE Consultation Request Form
First Name
Last Name
Email
Phone
Department/Division
Affiliation
Penn State University
Other
If "Other," Please Specify
PSU Status
Faculty
Fellow
Resident
Staff
Post-Doc
Graduate Student
Medical Student
PROJECT INFORMATION
Has project been submitted to or reviewed by the Institutional Review Board (IRB)?
Yes
No
Not Applicable
IRB Number
Is this a grant or contract proposal?
Yes
No
Project Title
Project Description
(4000 character limit) Use this space to describe your project and provide details that will help to explain your needs (i.e., description of your dataset, questions of interest, methods, etc.).
Desired Completion Date
Project Funding Status
Funds Available for Collaboration
No Funds Available for Collaboration
BILLING CONTACT INFORMATION
Billing Contact First Name
Billing Contact Last Name
Billing Contact Email
Billing Contact Phone
Contact Information