Center for Interdisciplinary Research and Consulting

Consulting Request Form for Off-Campus Clients

Contact Information

Name:
Position/Title:
Affiliation/Company:
Department/Unit:
E-mail Address:
Phone Number(s):	Primary
Phone Number(s):	Secondary
Fax Number:
Address:
Address, cont'd:
City:		State:	Zip Code:

Project Information

Please select a project type:

Corporate Research
Academic Research
Grant Proposal
Ongoing Funded Project
Other, please specify:

Briefly describe the nature of your project. In addition, please tell us how we can be of service:

Please specify the timeframe of the project:

What is your availability?

Monday:
Tuesday:
Wednesday:
Thursday:
Friday:

How did you hear about us?

Brochure
Web Site
Colleague
Other, please specify:

Disclaimer:
CIRC provides up to 2 hours of free initial consulting to assess your project and consulting needs. If additional time is required, charges may apply. Standard rates vary from $50.00 per hour to $250.00 per hour depending on type of work and availability of resources. Please click the check box below to acknowledge you have read and agree with the terms provided in this disclaimer.
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