Informatics Consultation Request Form

Last name:

First Name:

E-mail:

Phone:

Title:

Department:

School Affiliation:

Description of Project:

Please provide a brief description of need / project requirements

Are you a Cancer Institute Member?:

Yes

Is this a cancer research project?:

Yes

Is this or will it be an OCTRI study?:

Yes

OHSU — Oregon Health & Science University