MAPMG Research Interest Form Requestor Information Question Title * 1. First Name Question Title * 2. Last Name Question Title * 3. Email Address (@kp.org) Question Title * 4. Service Area DCSM NOVA Baltimore Regional Other (please specify) Question Title * 5. Department Question Title * 6. Position Resident Shareholder Track Physician Shareholder Physician Non-Shareholder or Hourly Physician MAPMG administrative staff Non-MAPMG; Kaiser Foundation Health Plan Other (please specify) Question Title * 7. What type of project or assistance are you interested in? I am seeking approval for an already prepared abstract or manuscript. I need assistance preparing an abstract (poster or talk) for a medical/scientific conference. I need assistance preparing a manuscript for submission to a medical/scientific journal. I need assistance with other writing services (resume, lit review, grant writing, etc.). I want to express an interest in conducting research or propose a specific research project or submit an IRB application. I would like assistance determining if my project is considered research. I would like to apply for research grant funding (NIH, foundation, etc.). I would like to request approval or support for an external academic degree program. I would like to sign up for a Permanente Pathways experience. Done