Biostatistics, Study Design, and Data Management Core

 

* Date: (Example 01/01/2010) Date: (Example 01/01/2010)

* Ongoing Study: Ongoing Study:   Yes No

If Yes, Please List Funding Source: If Yes, Please List Funding Source:

Grant Number: Grant Number:

* Please (Select All that Apply) Please (Select All that Apply)   Principal Investigator Faculty Visiting Scholar Research Scholar Research Associate Post Doctoral Fellow Research Staff Teaching Associate Clinical Assistant Student

If Student (Select All that Apply) If Student (Select All that Apply)   Masters Program PhD Program Medical Student Resident

* Department: Department:

* Name of Person Requesting Service Name of Person Requesting Service

* E-mail Address: (Example abc@abc.com) E-mail Address: (Example abc@abc.com)

* Phone: (Example:123-456-7890) Phone: (Example:123-456-7890)

* Principal Investigator of Study Principal Investigator of Study

* Project Title: Project Title:

Services Requested:

Services Requested:   Data Collection Form Development Database Development Manuscript Preparation	Proposal Development Sample Size and Power Calculations Statistical Analysis	Study Design
Other (please specify)