Today M-D-Y
First Name: Last Name: Institution/Organization: Location of Institution/Organization: Title or position: Phone number: Email address:
First name
* must provide value
Last name
* must provide value
Institution
* must provide value
Location of Institution/Organization
Email address
* must provide value
Project name or topic:
* must provide value
Briefly describe your project, goals, and desired outcome (up to 3-4 sentences), including how your project relates to or addresses Type 2 Diabetes.
If this is a research study, please include specific aims and study methods/design, as applicable.
* must provide value
Describe the population(s) you will be working with. Include any relevant details about geographic location, ages, race and ethnicity, gender, etc.
* must provide value
Location where the project will be taking place.
Please share any relevant deadlines associated with this project or topic. For example, planned project launch dates or grant proposal submission deadlines by month/day/year.
Please upload additional documents or materials to help us to better understand your project (e.g., Specific aims of a research project, program curriculum or other materials needing feedback, policy reports)
Document 1: Document 2: Document 3:
Are you requesting a letter of support as part of this request?
Yes
No
Making connections with potential collaborators
Recruitment and retention strategies or guidance
Community engagement approaches
Health equity frameworks
General research guidance
Study design or methods
Feedback on project or topic materials
Program evaluation
Hiring and training staff
Data collection
Data analysis methods
Feedback or advice on grant proposal developments
Sustaining programs and partnerships
Dissemination and publishing
Other (specify):
Making connections with potential collaborators
Recruitment and retention strategies or guidance
Community engagement approaches
Health equity frameworks
General research guidance
Study design or methods
Feedback on project or topic materials
Program evaluation
Hiring and training staff
Data collection
Data analysis methods
Feedback or advice on grant proposal developments
Sustaining programs and partnerships
Dissemination and publishing
Other (specify):
Making connections with potential collaborators
Recruitment and retention strategies or guidance
Community engagement approaches
Health equity frameworks
General research guidance
Study design or methods
Feedback on project or topic materials
Program evaluation
Hiring and training staff
Data collection
Data analysis methods
Feedback or advice on grant proposal developments
Sustaining programs and partnerships
Dissemination and publishing
Other (specify):
Making connections with potential collaborators
Recruitment and retention strategies or guidance
Community engagement approaches
Health equity frameworks
General research guidance
Study design or methods
Feedback on project or topic materials
Program evaluation
Hiring and training staff
Data collection
Data analysis methods
Feedback or advice on grant proposal developments
Sustaining programs and partnerships
Dissemination and publishing
Other (specify):
Making connections with potential collaborators
Recruitment and retention strategies or guidance
Community engagement approaches
Health equity frameworks
General research guidance
Study design or methods
Feedback on project or topic materials
Program evaluation
Hiring and training staff
Data collection
Data analysis methods
Feedback or advice on grant proposal developments
Sustaining programs and partnerships
Dissemination and publishing
Other (specify):
Making connections with potential collaborators
Recruitment and retention strategies or guidance
Community engagement approaches
Health equity frameworks
General research guidance
Study design or methods
Feedback on project or topic materials
Program evaluation
Hiring and training staff
Data collection
Data analysis methods
Feedback or advice on grant proposal developments
Sustaining programs and partnerships
Dissemination and publishing
Other (specify):
Collaborator - Community-based organizations
Community-based organizations
Community-based organizations
Collaborator - Clinical settings and healthcare providers
Clinical settings and healthcare providers
Clinical settings and healthcare providers
Collaborator - Government agencies
Government agencies
Schools
Collaborator - Faith-based organizations
Faith-based organizations
Faith-based organizations
Other collaborator
Please add brief details about your needs.
* must provide value
Please add any additional information about potential collaborators.
In what areas of Type 2 diabetes (T2D) expertise does your program or project need support? (check all that apply and add brief details about your needs below)
General expertise in T2D
T2D Complications
T2D Prevention
T2D Management
T2D Population Disparities
T2D Population Disparities
T2D Population Disparities
T2D and Basic Science
T2D and Genetics
T2D and Technology
T2D Interventions and Implementation
T2D Interventions and Implementation
T2D Interventions and Implementation
T2D Education
T2D and Implementation Science
T2D and Implementation Science
T2D and Implementation Science
Other diabetes area
T2D - Don't know/Not sure
Don't know/Not sure
Add brief details about your T2D expertise needs:
What are you seeking support on? (CHECK ALL THAT APPLY and add brief details about your needs)
Finding and securing funding:
Grant proposal development:
Feedback and advice on grant proposal development:
Making connections with potential collaborators (such as communities, clinics, schools, researchers, etc.):
Recruitment and retention strategies:
Study design or methods:
Feedback on project or topic materials:
Program evaluation:
Hiring and training staff:
Collecting, monitoring, and managing data:
Data analysis (qualitative or quantitative):
Sustaining programs and partnerships:
Presenting results to community/non-academic and/or academic audiences:
Other (describe):
Finding and securing funding:
Grant proposal development:
Feedback and advice on grant proposal development:
Making connections with potential collaborators (such as communities, clinics, schools, researchers, etc.):
Recruitment and retention strategies:
Study design or methods:
Feedback on project or topic materials:
Program evaluation:
Hiring and training staff:
Collecting, monitoring, and managing data:
Data analysis (qualitative or quantitative):
Sustaining programs and partnerships:
Presenting results to community/non-academic and/or academic audiences:
Other (describe):
Finding and securing funding (Describe)
Grant proposal development (Describe)
Feedback and advice on grant proposal development (Describe)
Making connections with potential collaborators (Describe)
Recruitment and retention strategies (Describe)
Study design or methods (Describe)
Feedback on project or topic materials (Describe)
Program evaluation (Describe)
Hiring and training staff (Describe)
Collecting, monitoring, and managing data (Describe)
Data analysis (qualitative and/or quantitative) (Describe)
Sustaining programs and partnerships (Describe)
Presenting results to community/non-academic and/or academic audiences (Describe)
Please describe your most urgent priorities and how CEDER may be able to support your work.
What is your role on the current project you are seeking support on?
Researcher or faculty member
Research study staff (e.g., Coordinator, manager, specify):
Student Postdoc, Trainee, or Fellow (specify):
Community leader
Community Educator/Navigator
Healthcare Team Member
Other (please specify):
Researcher or faculty member
Research study staff (e.g., Coordinator, manager, specify):
Student Postdoc, Trainee, or Fellow (specify):
Community leader
Community Educator/Navigator
Healthcare Team Member
Other (please specify):
Specify research study staff
Specify student postdoc, trainee, or fellow
Please select type of researcher or faculty member:
Early-career
Mid-career or later
Other (specify):
Early-career
Mid-career or later
Other (specify):
Other type of researcher (specify)
Please select type of community educator/navigator:
Peer educator
Certified diabetes educator
Community health worker/Promotor/a
Other (specify):
Peer educator
Certified diabetes educator
Community health worker/Promotor/a
Other (specify):
Other type of community educator/navigator (specify)
Please select type of healthcare team member:
Primary Care Physician/Nurse Practitioner/Physician Assistant
Psychiatrist/Psychologist
Endocrinologist
Registered Nurse
Pharmacist
Other (specify):
Primary Care Physician/Nurse Practitioner/Physician Assistant
Psychiatrist/Psychologist
Endocrinologist
Registered Nurse
Pharmacist
Other (specify):
Other healthcare team member (specify)
Planning (conceptualization, methodology, etc.)
Conducting (Implementation of intervention, data collection)
Dissemination (Relaying findings to audiences)
Other:
Planning (conceptualization, methodology, etc.)
Conducting (Implementation of intervention, data collection)
Dissemination (Relaying findings to audiences)
Other:
Is your work funded by a grant or contract?
Yes
No
If funded:
Funding source/Agency name: Grant number/funding number (if applicable): Stage of funding
Funding source/Agency name (if funded)
Grant number/funding number if applicable (if funded)
Stage of funding (if funded)
Early stage (funded but not initiated)
Established (funded and ongoing)
Early stage (funded but not initiated)
Established (funded and ongoing)
Have you submitted an application?
Previously submitted an application, but it was not funded
Have not submitted an application, but interested in submitting one
Previously submitted an application, but it was not funded
Have not submitted an application, but interested in submitting one
If previously submitted an application, but it was not funded:
Funding source/Agency name Date application was submitted
Funding source/Agency name (if not funded)
Date application was submitted (if not funded)
Today M-D-Y
Are you planning on submitting a new application?
Yes
No
If planning on submitting a new application:
Funding source/Agency name Funding application deadline
Funding source/Agency name (if not funded and submitting new application)
Funding application deadline (if not funded and submitting new application)
Today M-D-Y
If have not submitted an application, but interested in submitting one:
Funding source/Agency name Funding application deadline
Funding source/Agency name (if not funded)
Funding application deadline (if not funded)
Today M-D-Y
Please tell us how you learned about CEDER services and/or resources (CHECK ALL THAT APPLY):
Referred by Academic partner
Referred by a colleague/friend
Referred by someone who received services
Learned from other source
Please tell us how you learned about CEDER services.
Someone from an academic partner (specify):
Someone from a community partner (specify):
Referred by the Centers for Diabetes Translation Research (CDTR) Network
Referred by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK)
Referred by a colleague/friend (specify):
Referred by someone who received CEDER services (specify):
Viewed on the National CEDER Website
Viewed on social media
Other source (please describe):
Someone from an academic partner (specify):
Someone from a community partner (specify):
Referred by the Centers for Diabetes Translation Research (CDTR) Network
Referred by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK)
Referred by a colleague/friend (specify):
Referred by someone who received CEDER services (specify):
Viewed on the National CEDER Website
Viewed on social media
Other source (please describe):
Referred by Academic partner
Referred by colleague/friend
Referred by someone who received services
Learned from other source
Which social media platform?
LinkedIn
X (formerly known as Twitter)
Facebook
Other (please describe):
LinkedIn
X (formerly known as Twitter)
Facebook
Other (please describe):
Other social media platform
Have you previously contacted CEDER about services?
Yes
No
Have you previously contacted CEDER about the same project or topic?
Same project/topic
Different project/topic
Same project/topic
Different project/topic
If it was a different project or topic, please list the title:
When would you like to begin receiving services for this request?
One month from now
2-3 months from now
3-6 months from now
6-12 months from now
Other (specify):
One month from now
2-3 months from now
3-6 months from now
6-12 months from now
Other (specify):
When would you like to begin receiving services - other
What terms best describe your gender identity?
What is your race or ethnicity? (Check all that apply)
Other race or ethnic group
What specific American Indian or Alaska Native ethnic group(s) do you identify with? WRITE-IN
What specific Asian ethnic group(s) do you identify with? (Check all that apply)
What specific Black or African American ethnic group(s) do you identify with? (Check all that apply)
What specific Hispanic or Latino ethnic group(s) do you identify with? (Check all that apply)
What specific Middle Eastern or North African ethnic group(s) do you identify with? (Check all that apply)
What specific Native Hawaiian or Pacific Islander ethnic group(s) do you identify with? (Check all that apply)
What specific White ethnic group(s) do you identify with? (Check all that apply)