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:*




Faculty Rank:






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





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:*  


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:*



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:

Where did you hear about the Biostatistics Consulting Service?*  

 Previous Client 
 MCW Website 


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 or 414-955-8280.
© 2014 Medical College of Wisconsin
Page Updated 11/17/2014