MSUCOM / SCSStatewide Campus System

Scholarly Activity Consultation Request

Please note:

  1. "Scholarly Activity" (SA) project consultation services, including both Quality Improvement and research, are available to SCS-affiliated faculty, residents, fellows, and medical students.
  2. Please allow at least two workdays for your assigned SA consultant to contact and schedule your initial phone conference.
  3. If you request SCS consultation services, you are expected to maintain periodic contact with this consultant regarding project updates, additional requests, etc.  Please work to respond to consultant communications within seven days of your having received them.
  4. If your project results could not have been realistically completed and/or disseminated without SCS consultation, we ask that you:

    • Acknowledge the SCS on each dissemination product with the SCS logo or wordmark and,
    • List your consultant as final-listed presenter/author.

Name and credentials:

Email Address:

Clinical specialty, Residency Program, Healthcare System:

Status (Faculty, Resident / Fellow, Student):

Supervising faculty name and email (if applicable):

Primary telephone number:

Preferred method of communication, and best days/times to reach you:
Please note any expected delays in contact during the consultation period (one week or more)

Current Status of Project (check all that apply):





Who in your healthcare system or program currently works with data for other projects?
Please specify names and departments.
:

General period of project / SCS consultation services requested:

In a few sentences, please describe the topic area, aims, sample, etc. of your current/future SA project:

Please check the areas of assistance: