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Qualitative and Patient-Reported Outcomes Shared Resource
QPRO Service Request

If you are interested in utilizing the services of the Q-PRO Shared Resource, please complete the Service Request Form below. Please reach out at least 2 months before any requested work would begin. For grant proposals, please reach out at least 3 weeks prior to submission.

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Full Name Department Phone Number Email Address

Is the study PI a Cancer Center member? No Yes - CGM Member Yes - CPC Member Yes - NRO Member Yes - SBT Member

Is the project cancer-focused? No Yes

Project Title:

Which of the services are you requesting? Patient-Reported Outcomes Consultation Qualitative Research Consultation

Are the services for: Funded Project Grant Proposal Preparation Manuscript Preparation

If submitting a grant, what is the grant due date? What is the anticipated start date of Q-PRO services?

Funding Source/Anticipated Funding Source: Extramural (non-NIH) Intramural NCI NIH (excludes NCI) Other

Is the project funded? No Yes, extramural funding Yes, internal funding

Additional Notes:

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