Biostatistics Consulting Service

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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. 

   
     

P.I. E-mail:*

 
     
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 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 
 MCW Website 
 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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Page Updated 10/13/2014