[survey_date_completed_instrument]
Name* must provide value
Last name, First name
Role: Academic
Clinician
Student
Other
Industry
Community
Please specify
Please specify GP
Specialist
Resident
RN
NP
Dietician
Orthotist/prosthetist
Midwife
Dentist
Medical leadership
Other
Pharmacy
Please specify
Student Type Island Medical Program
Nursing
Social Work
RT
Other
Please specify
Affiliation or Organization* must provide value
Department
Affiliation Island Health
University of Victoria
University of British Columbia
Royal Roads University
Divisions of Family Practice
Other (please identify)
Other Institution:
I have discussed this request with, and received approval to proceed from my Island Health Manager, Director, or Executive Director. Yes
No
Telephone
E-mail address* must provide value
Please confirm your email address.* must provide value
Emails don't match. Please make sure emails match before continuing. What kind of research supports are you looking for? Please check all that apply. * must provide value
applying for research grants
developing a research question and building a team /finding an Island Health collaborator
connecting with students or volunteers
developing budgets and managing research contracts and finances
getting ethical and operational approval to conduct research
meeting research privacy requirements
clinical research training and compliance
engage in clinical research (including joining or conducting a clinical trial )
accessing, collecting, managing, or analyzing data
designing a survey
recruiting research participants through Island Health
moving evidence into policy and practice
sharing results through presentations, posters, and/or publications
Tell us more about your data needs. Would you like to (check all that apply):
access Island Health data
get help with analyzing data
And is that data:
qualitative
quantitative
both
not sure
To request access to Island Health data, please see this page for further information. Please provide a brief summary of your research project or activity.* must provide value
If you'd like to share a file related to your request (e.g. a project summary, poster, or publication), upload it here.
What type of collaboration/support do you require?
Research Project Collaborator
Course Development
Publication
Presentation
Integrated Knowledge Translation planning (the broad range of activities meant to improve the use of research evidence in practice, policy and further research)
Patient Oriented Research (a continuum of research that engages patients as partners, focuses on patient-identified priorities and improves patient outcomes)
Volunteer
Other (please identify)
Check all that apply
Research Project Title (if known)
Patient Oriented Research Support Type Access to Hub Methods Cluster
Access to patient partner
Knowledge Broker support
Research Navigator support
Methods Cluster(s) Evidence Reviews
Integrated Knowledge Translation
Data Sciences
Real-World Clinical Trials
Mixed Methods Research
Outcomes Measurement
Health Economics
Patient Engagement
Type of collaboration requested:
Please describe your project. Outline goals, objectives and specific aims if known (please limit to 150 words)
Anticipated duration of project
Desired start date Today D-M-Y
Please identify skills you are seeking for your project Budget development
Data access
Data management
Ethics support
Grant support
Knowledge translation
Permission to Contact
Brief concept of course
Seniors Health
Mental Health and Substance Use
Aboriginal Health or Indigenous Populations
Rural Health
Other (please identify)
Check all that apply
Other project area:
What type of support/opportunity are you seeking?
Paid research position
Volunteer research position
Co-operative education position
Applied research project
Other (please specify)
Do you have anyone in mind for this project? Yes
No
Name of potential collaborator
Have you already contacted the potential collaborator about this project? Yes
No
Island Health Geography 1: Campbell River, Comox, Courtenay, Mt. Waddington, Strathcona
Island Health Geography 2: Port Alberni, West Coast, Nanaimo, Oceanside
Island Health Geography 3: Cowichan Valley, Ladysmith, Saanich (Northern), Gulf Islands
Island Health Geography 4: Victoria, Saanich (Southern), Esquimalt, Sooke, West Shore
Specific Location:
Background intellectual property. Does this research project build upon, rely on or make use of any intellectual property? If so, please identify the owner(s) of the intellectual property
Island Health
University of Victoria
University of British Columbia
Royal Roads University
Other (specify)
Don't know
Background Intellectual Property Protection. Has a patent application or other statutory protection already been filed for the intellectual property identified above?
Yes
No
Research Support Staff Lead Diane Sawchuck Jenny Cartwright Tara Mcmillan Taylor Hainstock Uta Sbotofrankenstein Dawn Waterhouse Wendy Young
By submitting this form, I acknowledge that all information contained herein may be shared with the members of Vancouver Island Health Authority and affiliated academic insitution (if applicable) for the purpose of processing this collaboration request. Affirmed
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