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 researchers. Please select your position on campus:

faculty/staff

graduate student

undergraduate researcher

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 1 hour 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.

Basic project or consulting information (name, title, affiliation, and similar) will be posted publicly. If this is a problem, please inform your consultant.

Please click the check box below to acknowledge you have read and agree with the terms provided in this disclaimer.
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