Knowledge Translation Service Intake Form

Thank you for your interest in the Centre for Healthcare Innovations (CHI) Knowledge Translation services. To help us better understand your needs, please answer the following questions. After reviewing your request, we will schedule an initial cost-free consultation with you for further discussion.

1. Your Contact Information

*Name:

Position:

Institution/Organization:

Department/Unit:

*Email address:

2. Please indicate the category that best describes you:

3. What level of service (roughly) are you requesting?

4. What is the level of urgency of your request?

5. Please provide a brief description of your project and the nature of your KT request (be as specific as possible):

6. What Knowledge Translation service(s) would you like to discuss? (Please select all that apply)

7. Do you have funding available for planned Knowledge Translation services?


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