Center for Interdisciplinary Research and Consulting

Consulting Request Form for On-Campus Clients

Contact Information

Name:
Academic Department:
E-mail Address:
Phone Number(s):	Primary
Phone Number(s):	Secondary
Campus Address:

Our consulting services are available to faculty/staff, graduate students, and undergraduate research award recipients. Please select your position on campus:

faculty/staff

graduate student

undergraduate research awardee

If you are a student, please also supply the following information:

Advisor/Mentor Name:
Advisor/Mentor E-mail:
Advisor/Mentor Phone Number:
Advisor/Mentor Academic Department:

Project Information

Please select a project type:

Master's Thesis	Ph.D. Thesis
Classwork/Homework
Outside Consulting
Grant Proposal
Ongoing 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
Advisor
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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