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Your Environment. Your Health.

SRP Data Collection Form

Welcome to the SRP Data Collection Form!

Thank you for taking the time to provide this information. It is important to us as we prepare program materials, work to support your efforts to collaborate, and consider new initiatives.

We hope that you will find the form to be easy to use. If you have questions about content, please contact Michelle L. Heacock at or (919) 541-7824. If you have questions about the form, or suggestions for improvements, contact Maureen Avakian at or (919) 794-4701.

NOTE: When completing this form please only use English letters, numbers, and the following symbols:
  . , : ; ? & ' $ @ # _ - + * = / \ () [ ]
HTML tags are NOT allowed.

All required fields have the word (Required) after the label.

Your Contact Information

Program/Project Selection(s)

To begin, click on the name of your program from the drop-down list below. An additional drop-down box will appear for Multiproject Center Grants, with the names of the projects and cores in your program. You can select more than one project.

If you are reporting on a trainee or alumni accomplishment, please remember to also enter the information in CareerTrac.


Please submit outreach, education, and translation materials that your program has created to the PEPH Resource Center at

If you need an NIH/EXT account to access the PEPH Resource Center, or have questions about the Resource Center, please contact Lynn Albert ( 919-794-4709.


Please note: the activity type and science type fields have been combined.



If you have questions about the Datasets, please contact Lesley Skalla ( 919-794-4700.

Unique dataset identifier such as accession number (e.g., GDS3325) or Data DOI (e.g., doi:10.5061/dryad.b0v7h). Required, if "Dataset title" is filled in.
Required, if "Dataset title" is filled in.

Publication PMID and/or DOI associated to this dataset

Thank you for providing this information! If you have photographs or other documents you would like to share related to this activity, please email the files to After you click "Submit your request" you will be taken to a page that lists all entries from this Web session. You will be able to view and edit your entries for 20 minutes or as long as your browser is active.