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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Page Updated 12/01/2016
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