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:*

E-mail:*

   

Are you a CTSI member?*

Yes        No

Are you a member of the MCW Cancer Center?*

Yes        No

   

P.I. Name:*

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 Services?*

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 01/30/2014