Community Based Research Intake Form If you are interested in having a research project completed by faculty at one of the PICCE institutions, please fill out the form below. Community Based Research Intake Form Organization Contact Persion Email Address Phone Number Project Title Project Description Project Discipline Art Biology Business Chemistry Communications Computer Science Education Environmental Health History Mathematics Music Physics Psychology Sociology Youth Development Other Project Discipline Research Questions Click "Add" to add additional research questions. Question Add Remove Potential Data Sources Have data Need data Unsure Scope of research Local Regional National Planned use Advocacy Evaluation/reporting Grant/funding development Presentations Publications OtherOther Resources available Funding for faculty Staff time OtherOther Desired start date Desired completion date If you are human, leave this field blank. Submit