Clinical/Population Research Request Form Principal Investigator (PI) Name* First Last Investigator Requesting Service (if different than PI) First Last Email Address* Department/Division*Project Title*Are you a HERCULES investigator?*YesNoAre you a HERCULES pilot project recipient?*YesNoAre you collaborating with other HERCULES investigators on this project?*YesNoWho are you collaborating with?Current Stage of Project* Pilot Proposal Planning External Grant Planning New Project Development Other Describe the current stage of your projectProject Description (in general terms)*What type of assistance do you need?* Study Design Consultation Grant Development/Review Networking with Population/Clinical Resource Other Describe type of assistancePhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.