The code block below illustrates how one might use # and // as comments in your logic and calculations.

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Required format:

6nnTw9IDWAqXc76jfUeUqnrvXFziVGBJIM3k5VGebN9pqIKK8zkHj4uHhCXbkoek

Institute for Health Equity Research Consultation Request Form

The purpose of the IHER Disparities Research Consultation Service is to respond to requests from Mount Sinai investigators for expert advice from experienced disparities researchers or from community members. This service is intended to encourage and enhance the conduct of health equity science across the Mount Sinai Health System. This consultation service includes up to 2 hours of free consultation service. Service beyond two hours may be arranged for a fee.

Please submit your responses to the following questions so that we can most appropriately meet your research needs. We will respond to your inquiry wiithin 5-7 business days to set up a time to review your request. If you have questions, please email Lauren Gordon at lauren.gordon@mountsinai.org

Requester First Name

* must provide value

Requester Last Name

* must provide value

Best contact phone number:

* must provide value

Email:

* must provide value

Are you affiliated with Mount Sinai?

* must provide value

Yes

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What is the primary reason for requesting consultation services?

* must provide value

Please specify:

* must provide value

What is the target population of your study?

* must provide value

What are your study's aims, research questions and/or hypotheses?

* must provide value

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Select all areas that apply to your research:

Population Health/ Public Health/ Health Policy

Aging Research

LGBTQ+ Research

Health Services/ Health Equity/ Health Disparities Research

Comparative Effectiveness Research

Basic Science

Genetics and Genomics

Cancer Research

Community-based participatory research

Clinical Trials

Clinical/ Translational Epidemiology

Global Health

Environmental Health

Behavioral Research

Pediatric/ Adolescent Health Research

Women's Health

Gender Equity

Other Research Area

Please specify your other research area:

Would you like to consult with a health disparities research consultant in the areas listed above?

Yes

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Is the study for which you are requesting consultation currently grant funded? (Please note that grant funding not required to request a consultation)

* must provide value

Yes

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Are you the Pl of the study for which you are requesting consultation?

* must provide value

Yes

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Please indicate below if you are interested in connecting with an IHER Community Consultant.

Community consultants may help researchers:

Design research that may be more easily translated into real-world health settings and situations.
Develop cultural- and language-appropriate communication and interventions.
Plan or improve participant recruitment, enrollment, and retention strategies.
Identify and address risks to a specific community by developing appropriate safeguards.
Incorporate lived experience, commonly held perceptions or beliefs into questions, hypotheses, or data interpretation.
Explore new ways to reach and include under-represented and under-served populations in clinical research.
Learn how to build greater trust between academic researchers and communities, and how to build community collaborations.

Would you like to consult with an IHER community consultant?

Yes

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Other comments:

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Timestamp

Y-M-D

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