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Pepper Center Request Form

Please complete the request form so that the Pepper Center may match you with appropriate expertise. You will receive a confirmation email upon successful submission, and we will contact you shortly thereafter to arrange an initial consultation.

More information about Northwestern's Pepper Center can be found here.

Request Date

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M-D-Y

Project Deadline

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M-D-Y

First Name

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Last Name

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Are you the Principal Investigator for the project?

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Yes

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Principal Investigator First Name

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Principal Investigator Last Name

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Principal Investigator Title

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If "Other", please specify

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Principal Investigator Netid

Principal Investigator Email

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Institution

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NU - Feinberg School of Medicine

NU - Non-Feinberg

Shirley Ryan AbilityLab

Robert H Lurie Comprehensive Cancer Center

Northwestern Memorial HealthCare

External-Rush University Medical Center

External-UIC

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Type of Project

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Grant Development

Technology Design

Manuscript, Abstract, Presentation or Poster

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Title of Project

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Brief description of needs (please keep to 2-3 sentences)

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Type of consultation requested pertains to (check all that apply)

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Study design

Power/sample size calculation

Database setup

Data analysis

Qualitative analysis

Patient Reported Outcomes

Design and Technology

SHARPS - Community/Stakeholder Feedback

Other

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Are there statistical programs in use?

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SAS

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Stata

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None/Unknown

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Are there any other computer programs in use?

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REDCap

SQL

Access

Python

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None/Unknown

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Prior experience with Qualitative Methods

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Novice (no prior Qualitative experience)

Beginner (limited Qualitative experience, e.g., led focus groups/conducted interviews)

Intermediate (some Qualitative experience, e.g., created interview guides, participated in analysis)

Advanced (extensive Qualitative experience, e.g., led qualitative project, led analysis, etc.)

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Type of Qualitative consultation

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Introductory discussion (e.g., assistance and guidance in planning a qualitative study or considering a qualitative component/aim in a study)

Grant proposal discussion (e.g., seeking feedback on type of design/analysis plan, sample size discussion, writing/review of qualitative section)

Budget discussion (e.g., guidance on what to plan for in terms of costs, including personnel (skill level and effort), analysis software, transcription costs, etc.)

Focus group/interview guide development (e.g., seeking feedback on questions within interview guide)

What is your role on this grant proposal?

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Principal Investigator (PI)/Multiple Principal Investigator (MPI)

Co-Investigator (Co-I)

Consultant

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Please describe your role

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List the names and roles (PI, MPI, Co-I) of other Northwestern University and external researchers involved in this research proposal:

Name

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Role

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Affiliation

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Additional Investigator to add?

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Yes

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Name

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Role

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Affiliation

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Additional Investigator to add?

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Yes

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Name

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Role

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Affiliation

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Additional Investigator to add?

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Yes

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Name

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Role

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Affiliation

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List the target funding mechanism for your proposal (e.g. Funder Grant Activity Code [P50, R01, etc] and FOA, RFP, RFA, PA, or NOT number) and provide the link describing the funding mechanism.

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Which of the following best describes your Research Team:

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Includes a PI/Co-I with expertise in Qualitative Research

Includes a research/study coordinator/analyst with expertise in Qualitative Research who can oversee design and analysis

Includes a research/study coordinator/analyst with limited expertise in Qualitative Research

No members of the current research team have Qualitative Research expertise

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Please attach any relevant documents, based on consultation type (e.g., specific aims page, draft interview guide, qualitative budget, etc.)

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Are you in the Pepper Scholars Program?

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Yes

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Any other comments that will be helpful prior to consultation?

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Resource Core Assigned

Analytics Personnel Assigned

Design Personnel Assigned

Measurement Personnel Assigned

REC/PESC person assigned

Date Assigned

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Date Index Meeting with Study Team

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Date Completed

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Hours worked on project

Notes

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Pepper Center Request Form

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