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Required format:

Request for Research Support

Thank you for connecting with Island Health's Research Department! Let us know how we can help by completing this short form, and we'll be in touch.

Date

Y-M-D

Name

* must provide value

Role:

Academic

Clinician

Student

Other

Industry

Community

Please specify

Specialist

Resident

Dietician

Orthotist/prosthetist

Midwife

Dentist

Medical leadership

Other

Pharmacy

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Please specify

Student Type

Island Medical Program

Nursing

Social Work

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:

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I have discussed this request with, and received approval to proceed from my Island Health Manager, Director, or Executive Director.

Yes

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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

engaging patients as equal partners in research (patient-oriented research)

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

WAIT! If you're applying for a grant or looking for a letter of support, please complete this survey instead:

Letter of Support Request & Notice of Intent Form

Tell us more about your data needs. Would you like to (check all that apply):

access Island Health data

collect and manage data (using REDCap)

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

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If you'd like to share a file related to your request (e.g. a project summary, poster, or publication), upload it here.

Upload file

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)

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:

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Please describe your project. Outline goals, objectives and specific aims if known (please limit to 150 words)

Expand

Anticipated duration of project

Desired start date

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

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Seniors Health

Mental Health and Substance Use

Aboriginal Health or Indigenous Populations

Rural Health

Other (please identify)

Other project area:

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What type of support/opportunity are you seeking?

Paid research position

Volunteer research position

Co-operative education position

Applied research project

Other (please specify)

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Do you have anyone in mind for this project?

Yes

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Name of potential collaborator

Have you already contacted the potential collaborator about this project?

Yes

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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:

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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

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Background Intellectual Property Protection. Has a patent application or other statutory protection already been filed for the intellectual property identified above?

Yes

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Research Support Staff Lead

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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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.