Membership Request for Consortium of Research-Intensive Schools of Health Professions
Fields marked with an asterisk * are required.
Your institution and school
*
Name of person completing this form
*
Email address of person completing this form
*
example@example.com
Name of school's dean
*
Full title(s) and credential(s) for school's dean
*
Email address of school's dean
*
example@example.com
Phone number of school's dean
*
Please enter a valid phone number.
Format: 000-000-0000.
Link to official bio webpage for school's dean
Please enter a webpage URL.
Name of school's associate dean for research
*
Full title(s) and credential(s) for school's associate dean for research
*
Email address of school's associate dean for research
*
example@example.com
Phone number of school's associate dean for research
*
Please enter a valid phone number.
Format: 000-000-0000.
Link to official bio webpage for school's associate dean for research
Please enter a webpage URL.
Current number of extramurally funded research grants and contracts, including extramurally funded research training grants
Please list sponsors of current research grants and contracts (e.g.,NIH, NSF, NIDLIRR, DoD, AHRQ, etc.)
Current annual DIRECT costs from research grants andcontracts projected in current-year budget
Current annual INDIRECT costs from research grants and contracts projected in current year budget
Number of faculty with assigned research effort of 50% orgreater
Other information to support application (e.g. reasons forapplying; hoped for benefits; etc.)
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