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:	AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY	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:   

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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.

I Accept

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