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Required format:

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/^((02([-\/])29\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1[012])([-\/])(0[1-9]|1\d|2[0-8]))|((0[13-9]|1[012])([-\/])(29|30))|((0[13578]|1[02])([-\/])31))(\11|\15|\19)\d{4}))$/

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Request for Services

Thank you for your interest in utilizing the Rural Research Network.

The mission of the RRN is to improve the health of Arkansans by engaging individuals living in rural areas of Arkansas in clinical and translational research.

Studies are reviewed according to their alignment with the RRN mission. At a minimum, studies performed within the RRN should do the following:

Enroll patients that are receiving their care in the UAMS Regional Programs
Involve collaboration with a faculty member working in UAMS Regional Programs
Address a disease area that is of high priority to rural and/or under-represented individuals in Arkansas

Requests are presented to the Network's leadership team and/or review committee and medical directors of Regional Programs for consideration and approval. Due to limited resources and availability, not all projects will be accepted.

Studies are expected to have some level of research support, such as NIH, foundation, or industry support to receive RRN support.

For Billing, IRB and/or Programming and Data Management Services, submit a separate request thru the TRI Portal, https://tri.uams.edu/contact-tri/request-services-portal/

Date of Request

* must provide value

M-D-Y

PI Name

* must provide value

Is the project funded?

Studies are expected to have some level of research support, such as NIH, foundation, or industry support to receive RRN support. Non-funded studies will not be supported by the RRN.

* must provide value

Yes, already awarded to UAMS or awarded intramurally

Yes, immediately available pending execution of a funding agreement (i.e., with an industry or foundation/non-profit sponsor or might be a federal subaward from another academic institution).

No, but pending a Grant Application

No current or future funding opportunity

Other

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Non-funded studies are not supported by the Rural Research Network

If you selected 'Other', please specify

* must provide value

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Type of funding mechanism:

* must provide value

Federal Grant Submission

Foundation/Non-Profit Sponsor

Industry Sponsored

Intramural Grant Submission

Federal Subaward from Another Academic Institution

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Include Type of Submission

* must provide value

If you selected 'other', please explain

* must provide value

Date of Submission

* must provide value

M-D-Y

How would you like to share the PA/FOA?

* must provide value

Upload the PA/FOA

* must provide value

Upload file

Provide URL to PA/FOA

* must provide value

Will a letter of support be needed?

* must provide value

Yes

reset

Project/Reference Title

* must provide value

Concept Paper: Upload a description of the project - A brief abstract; Impact statement; A brief summary of the approach including what data is collected, how many times, when, from whom, etc.

* must provide value

Upload file

Please provide a brief explanation of why it is important to conduct the project in a rural setting versus an urban setting

* must provide value

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Project Period

Beginning Period

* must provide value

M-D-Y

Ending Period

* must provide value

M-D-Y

Target Enrollment

* must provide value

Does the project include follow up with participants?

* must provide value

Yes

reset

If yes, Specify Frequency

* must provide value

How many per follow-up?

* must provide value

Specify Funding Agency

* must provide value

Date of submission

* must provide value

M-D-Y

Will a letter of support be needed?

* must provide value

Yes

reset

Upload the application guidelines

* must provide value

Upload file

Concept Paper: Upload a description of the project - A brief abstract; Impact statement; A brief summary of the approach including what data is collected, how many times, when, from whom, etc.

* must provide value

Upload file

Please provide a brief explanation of why it is important to conduct the project in a rural setting versus an urban setting

* must provide value

Expand

Project Period

Beginning Period

* must provide value

M-D-Y

Ending Period

* must provide value

M-D-Y

Target Enrollment

* must provide value

Does the project include follow up with participants?

* must provide value

Yes

reset

If yes, Specify Frequency

* must provide value

How many per follow-up?

* must provide value

Specify Sponsor

* must provide value

Date of Submission

* must provide value

M-D-Y

Upload a description of the project - A brief abstract; Impact statement; A brief summary of the approach including what data is collected, how many times, when, from whom, etc.

* must provide value

Upload file

Provide a brief explanation of why it is important to conduct the project in a rural setting versus an urban setting

* must provide value

Expand

Project Period

Beginning Period

* must provide value

M-D-Y

Ending Period

* must provide value

M-D-Y

Target Enrollment

* must provide value

Does the project include follow up with participants?

* must provide value

Yes

reset

If yes, Specify Frequency

* must provide value

How many per follow-up?

* must provide value

Include Type of Submission

* must provide value

Specify type of TRI Funding

* must provide value

Specify

* must provide value

Include Date of Submission

* must provide value

M-D-Y

Upload the RFA

* must provide value

Upload file

Will a letter of support be needed?

* must provide value

Yes

reset

Concept Paper: Upload a description of the project - A brief abstract; Impact statement; A brief summary of the approach including what data is collected, how many times, when, from whom, etc.

* must provide value

Upload file

Provide a brief explanation of why it is important to conduct your project in a rural setting versus an urban setting

* must provide value

Project Period

Beginning Period

* must provide value

M-D-Y

Ending Period

* must provide value

M-D-Y

Target Enrollment

* must provide value

Does the project include follow up with participants?

* must provide value

Yes

reset

If yes, Specify Frequency

* must provide value

How many per follow-up?

* must provide value

Include Type of Subaward

* must provide value

Include Academic Institution

* must provide value

Include Date of Subaward

* must provide value

M-D-Y

Will a Letter of Support be needed?

* must provide value

Upload Scope of Project - Include a brief summary of the approach including what data is collected, how many times, when, from whom, etc.

* must provide value

Upload file

Please provide a brief explanation of why it is important to conduct the project in rural setting versus an urban setting

* must provide value

Expand

Beginning Period

* must provide value

M-D-Y

Ending Period

* must provide value

M-D-Y

Target Enrollment

* must provide value

Does the project include follow-up with participants?

* must provide value

Yes

reset

If yes, Specify Frequency

* must provide value

Yes

reset

How many per follow-up?

* must provide value

Yes

reset

What type of RRN services are needed? The estimated costs for the services must be budgeted within the grant award. Check all that apply.

* must provide value

Project Management

Recruitment from regional programs

Research coordinator services

Engagement of clinical services within regional programs

Other

Don't Know/Not Sure

If you selected 'Other' in response to what type of services are needed, please specify:

* must provide value

Expand

For "Engagement of clinical services within regional programs", check all that apply:

* must provide value

Medical

Laboratory (i.e., blood sample collection)

Telemedicine

Other

Don't Know/Not Sure

If Other is selected, describe the type(s) of clinical services needed

* must provide value

Expand

For 'research coordinator services', check all that apply.

* must provide value

Participant Recruitment

Screening for Eligibility

Consenting Participants

Conducting Research Appointments

Collecting data and/or biometrics (i.e., administration of survey instruments, HbA1c, BMI, blood pressure, etc.)

Other

Don't Know/Not Sure

Describe the type(s) of data and biometrics needed:

* must provide value

Expand

For the collection of samples, specify the type(s) of samples to be collected

* must provide value

Expand

For Other Services, specify other types of support needed

* must provide value

Expand

If you selected 'Engagement of clinical services within regional programs when available', describe the type(s) of clinical services needed:

* must provide value

Expand

Which regional programs site(s) are you considering? Please check all that apply.

map of AR with rural research network sites

* must provide value

UAMS East - Helena/West Helena

UAMS North Central - Batesville

UAMS Northeast - Jonesboro

UAMS Northwest - Fayetteville/Springdale

UAMS South - Magnolia

UAMS South Central - Pine Bluff

UAMS Southeast - El Dorado

UAMS Southwest - Texarkana

UAMS West - Fort Smith

Don't Know/Not Sure

I understand projects accepted by the Network will adhere to the following:

Budget for use of the Network's research support team including the appropriate effort for the required support staff and all related project costs utilizing TRI's existing charges for clinical trials.

Provide opportunities for UAMS Regional Programs' faculty and residents to engage in the scholarly activities that are part of the research (i.e., publications, presentations).

Provide a copy of the grant to the network director and access to the approved protocol and supporting documents

Participate in the establishment of an MOU that outlines the expectations of all participating parties.

Cite TRI using TRI.uams.edu/cite.

Present study to RRN stakeholders as requested.

Acknowledge RRN when presenting or publishing.

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.