Consulting Request Form for Off-Campus Clients


Contact Information

 

* Required
*Name:
Position/Title:
Affiliation/Company:
Department/Unit:
*E-mail Address:
Phone Number(s): Primary      
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:

Attachment:   


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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