Simplified Project Intake Form

1. Project Title (what you put here will be used in all communications moving forward unless you submit a request to unccnoperations@unc.edu to have the name changed)

2. Is this activity Cancer related?

3. How is this activity Cancer related?

4. Date

5. Time

6. Location

7a. Primary Organizer Name

7b. Primary Contact Phone Number

7c. Primary Organizer Email Address

8. Please select if this event will be fully in person, hybrid or online?

9. If online or hybrid, what digital platform will be used to host the meeting? (examples: Zoom/Webex/Teams, leave blank if unsure and we can follow up)

10. Do you want this to be recorded?

10a. Please note the we use what we refer to as "once and done" video editing. We will trim the beginning and end of the video. If there is a major disruption, such as a coughing spell, we will remove it. UNCLCN does not have the resources to handle more extensive editing in most situations. Unless there is a special agreement, all more extensive editing will need to be managed by an outside group. Please click the checkbox to acknowledge the you understand our editing policy.

I acknowledge and understand the editing policy of UNCLCN

10b. If you want this project to be recorded we will need all presenters and speakers to fill out and sign off on our recording consent forms which you can find the links to below -UNC employee video consent form - https://unc.az1.qualtrics.com/jfe/form/SV_eWYlVNmuKZTAM8S
Non-UNC employee video consent form - https://unc.az1.qualtrics.com/jfe/form/SV_3JldUkRdGU2apIW

I understand these forms will need to be filled out by each speaker in order to have this event recorded

11. Will continuing education credit be awarded for this activity?

12. Would you this event advertised to a statewide audience in our newsletter?

13. Link to current event webpage (if applicable)

14. Please list any special requests, other organizers, or other information we should know about this project

15. Will this project be recurring or 1 time only?

Unfortunately we do not support any non-cancer related projects

Please contact school of medicine IT for further assistance - https://www.med.unc.edu/it/

Contact Information