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.

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

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)

Check this box if you do not want SRP to share the information with other grantees or stakeholders (e.g., pre-publication data, results presented in an embargoed paper) (Optional)

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

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: (Optional)

Activities

Activity Type (Optional)

If Other is selected for "Activity Type," please describe here (Optional)

Activity Title (Optional)

Activity Start Month (Optional)

Activity Start Year (Optional)

Brief Summary (Optional)

Link(s) to Resources (Optional)

Collaborations

Collaborating SRP Center (if applicable) (Optional)

Work with Native American communities? (Optional)

Science Updates

Science Type (Optional)

Start Month (Optional)

Start Year (Optional)

Brief Summary (Optional)

Link(s) to Resources (Optional)

To prevent spam, please answer the following math problem (use numbers):
Four add

Nine (Required)

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 srpinfo@niehs.nih.gov. 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.