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 heacockm@mail.nih.gov or (919) 541-7824. If you have questions about the form, or suggestions for improvements, contact Maureen Avakian at avakian@niehs.nih.gov or (919) 794-4701.

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

Your Contact Information

Your Name: (required)

Email address: (required)

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.

Program: (required)

Tool/Output

Please submit outreach, education, and translation materials that your program has created to the PEPH Resource Center at https://connect.niehs.nih.gov/peph.

If you need an NIH/EXT account to access the PEPH Resource Center, or have questions about the Resource Center, please contact Lynn Albert (albert2@niehs.nih.gov; 919-794-4709.

Material Submitted:

Activities

Activity Type:

If Other is selected for "Activity Type," please describe here:

Activity Title:

Activity Start Month:

Activity Start Year:

Brief Summary:

Link(s) to Resources:

Collaborations

Collaborating SRP Center (if applicable):

Work with Native American communities?

Science Updates

Science Type:

Start Month:

Start Year: