Inquiry Form

To initiate research involvement with the CRN, please complete the following form.

Required fields are marked with an asterisk ( * ).

* Your name:
* Your e-mail address:
	Send a carbon copy of this message to yourself
Are you in the vicinity of a CRN site? (Your inquiry will be forwarded to your local site's collaboration coordinator, or to the CRN Executive Committee if not.)
Are you a National Institutes of Health Colleague? (If so, your inquiry will be copied to Martin Brown, PhD, NCI's CRN Program Officer.)	Yes No
* Your role/title:
* Your institution:
* Your current or past collaborations with CRN projects and/or investigators:
* Your research interests (keywords or general description):

If you have a specific project proposal:

A brief description of the project team:
A statement of the main Hypothesis/Research question(s):
Nature of the data required -- automated data, chart review, survey, etc.:
Estimated timeline to develop and submit proposal:
Nature of Proposal (type of grant or contract, funding agency):

Once a collaboration is established, the CRN PI office will ask you to complete the Collaboration Evaluation Survey.

Map of CRN sites: