Research Project Registration Form

If you want to request help with a database for administrative purposes only you are in the wrong place. Please go to Pediatric IS website from InfoScope. For assistance filling out this form, please contact a member of Quantitative Health Services at (414) 955-7675.

Investigator Information

First Name

Last Name

Title

Faculty Rank

Department/Division

Phone

Email

Are you a CTSI member?  Yes   No

Are you a member of the MCW Cancer Center?  Yes   No

P.I. first name*

P.I. last name

Email

Is your P.I. a CTSI member?  Yes No

Is your P.I. a member of the MCW Cancer Center?  Yes   No

*MCW Faculty must be named as Principal Investigators.

Project Information

Title of Research Project

Is this a cancer related project?  Yes   No

Do you have IRB approval?  Yes   No

QHS Services Requested

Biostatistical consultation

Study design

Biostatistical design

Survey development

Biostatistical analysis

Database development*

Collaboration on an IRB proposal

Scannable form development*

Collaboration on a grant proposal

Data collection tool development*

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8701 Watertown Plank Road
Milwaukee, WI 53226
(414) 955-8296
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Page Updated 08/20/2017
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