Research and Editing Consultants Program


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Consultant Application

Name:
Title:
Date of request:
Street Address:
City:
State:
Zip:
Email:
Phone:
Fax:
  1. Consulting language:

  2. Is this your native language?

    Yes  (go To #3)      No  (go To #4)
  3. How much of your education was completed in this language?
    years or degree completed (go to #5)
  4. Describe your background in this language (education, experience, etc.)  
  5. Do you currently use this language as the primary language in your professional and personal life (speaking, reading, writing, listening, thinking)?

    Yes  (go to #7)    No  (go to #6)
  6. Please briefly describe your experience


  7. Please indicate whether you currently have a university-level of proficiency in the language on each of the following dimensions:

    Speaking: Yes   No
    (describe)


    Writing: Yes   No (describe)

  8. Description of article content and current status of article

  9. Description of support requested: check all that apply
    Design
    Data collection
    Methodology
    Editing
    Other
    Please describe:

  10. Are you willing to share authorship?
    Yes   No
  11. Please feel free to add any additional information. 

Neuropsychology Lab
Western State Hospital
P.O. Box 2500
Staunton, VA 24402-2500
Telephone: (540) 332-8391
Fax: (540) 332-8385