Letter of Support Request - DFMCH Research Services Hub

Thank you for your interest in obtaining a Letter of Support (LOS) from the Department of Family Medicine and Community Health (DFMCH), the Primary Care Research and Learning Network (PCRLN), and/or PCRLN-affiliated clinics in support of your grant application.

Does your project include collaboration with family medicine residency clinics? *

If your project involves recruiting patients, engaging providers or residents, or may impact clinic operations, additional approvals may be required from the Clinic Research Review Committees, Program Directors, or clinic operations leadership. As such, these requests must be submitted at least 6-8 weeks in advance to allow for adequate review and coordination.

Please note that a LOS indicates willingness to collaborate and support recruitment planning, but it is not a binding agreement. If funding is awarded, investigators must still submit a recruitment request or proposal for review and approval by the relevant clinics. This ensures projects are feasible and aligned with clinic capacity and patient needs.

By submitting your request through this form, you acknowledge and agree to follow this process to ensure timely, coordinated, and appropriate support for your project.

Please allow a 1 week turnaround time to receive the letter of support.

Name*

Email*

Phone*

Project/Grant Name*

Date needed by*

PI Department / Organization

Project PI

Who does the letter need to come from? (e.g. Department Chair, Vice Chair for Research, Clinic Medical or Program Director, etc.)

Does this letter need to come from someone specific?

Please specify

Brief description of the project and why the letter is needed

Have you discussed the project with anyone at the DFMCH?

Will clinics be compensated?*

Please provide information about your compensation plan.*

Clinic support helps ensure time and effort can be dedicated to your project. If no, please briefly explain.*

Please specify

Please provide a link to the funding mechanism.

Upload Supporting Documents

Please upload any fliers or marketing materials for your project.
If this project involves informed consent, please upload the form participants will complete.

Uploaded Supporting Documents

Thank you for your interest in obtaining a Letter of Support (LOS) from the Department of Family Medicine and Community Health (DFMCH), the Primary Care Research and Learning Network (PCRLN), and/or PCRLN-affiliated clinics in support of your grant application.

Contact Information

Letter of Support Information

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