Consulting Application

If you are a CTSI member, you can apply for a mini-grant supporting biostatistical assistance on the Biostatistical Consultation Mini-Grants webpage.
Link to Consulting Prices

Completion of projects take a minimum of two weeks from receipt of date.

This form is used in matching the client’s needs with the proper statistical expert in order to ensure the best possible services. This form must be returned to the Division of Biostatistics before an appointment can be scheduled.

* required fields

First Name:*

 

Last Name:*

 

Title:*

 

Faculty Rank:

 
     

Department:*

 

Division:

 
     

Address:
(If non-campus, please provide your address.)

 

Phone:*

 

Email:*

 
     
Are you a CTSI member?*    Yes    No

Are you a member of the MCW Cancer Center?*

   Yes    No
     

P.I. Name:*
(For residents, fellows, students, and staff at academic institutions the PI has to be a faculty member.)

 

PI Title:*

 
PI Faculty Rank:*  

     
Department:*  
Division:  

P.I. Email:*

 
     
Is your P.I. a CTSI member?*    Yes    No

Is your P.I. a member of the MCW Cancer Center?*

   Yes    No
     
Title of Research Project:*  


 

     
Is this a grant funded project?    Yes   No
     
Is this a grant preparation project?*    Yes    No

Where are you submitting the grant?

 

Type of Research:*

 

 Clinical 
 Translational 
 Other      

     
Is this a cancer related project?*  

 Yes    No

     

Stage of Research:*

 

 Design (no data yet)
 Grant Preparation
 Data Collection
 Analysis (data collected)
 Peer Review

 

Do you have IRB Approval?*  

 Yes    No

 

If yes, please provide Institution and IRB approval number:  
     
If design is complete, was a statistician consulted for design?    Yes    No

If yes, provide name of statistician:

 
     
Deadline:  
     
Where did you hear about the Biostatistics Consulting Service?*  

CTSI
Previous Client
Colleague
Other
N/A

 

if other, please explain:

 
     

Description of project:*
(Include the scientific background and the specific aims)

 
     
Description of data:*  

 

After submission you should receive a confirmation email containing the application information. If you do not receive an email, contact the Division of Biostatistics consult@mcw.edu or 414-955-8280.
 

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