Thank you for your interest in submitting a request for Research Support. This form is designed to help streamline data, consultation, and survey requests related to medical education at the Larner College of Medicine.
Before You Begin
Personal and Professional Information
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- Name, email, phone number, title/role, and department/program affiliation.
- If you are a student, include your mentor's information.
Details of Your Request
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- Are you requesting a research consultation, survey dissemination, or medical education data?
- For survey requests, be prepared to specify the target classes, distribution timeline, and survey dissemination plans.
- For data requests, describe the data needed (e.g., years, cohorts) and the intended use of the information.
Supporting Documentation
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- Draft surveys, study protocols, IRB approvals/exemptions, or other relevant materials.
Project Information
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- A brief description of your project, collaborators, intended analyses, and dissemination plans (e.g., presentations, publications).
Deadlines and Additional Notes
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- Any submission deadlines or unique considerations for your request.
Important Notes
- If your request pertains to medical student financial aid data, please contact Student Financial Services directly.
- Completion of this form does not guarantee approval; requests are reviewed for compliance, feasibility, and alignment with institutional policies.
Once you submit the form, a member of the Teaching Academy Team will reach out within 3–5 business days to discuss your request further. Thank you for helping us enhance educational research and scholarship at Larner College of Medicine.