Application for Statistical & Epidemiological Support

Phone numbers

Phone (Required)

Office Phone

Fax

Office Fax

Mailing Address

Department (Required)

Institute (Required)

Building and Room Numbers

Street (Required)

City (Required)

State (Required)

Postal Code (Required)

Project Information

Title of Research Project (Required)

Specific Aims of Study (Required)

Stage of Research (Required)

Preliminary study
Grant writing
Data collection
Data analysis

Support Requested (Required)

Preliminary data analysis

Proposal preparation

Questionnaire development

Sample size/study power estimation

Database development/management

Statistical analysis

Result evaluation/presentation

Other

Specify other support requested

Funding status (Required)

Applying for funding
Funded
No funds available

Source of data (Required)

Own data
Data covered under the USMCI/NCI collaborative protocols
Not applicable

IRB Review Status (Required)

Approved
Pending approval
No human subjects involved

Institution and IRB approval number

If IRB approved, provide the Institution name and IRB approval number.

Data description

If data analysis is requested, please briefly describe the data such as comparison groups, sample size, data features, database format, and so on.

Products expected from the work (Required)

Grant proposal

Protocol not for funding

Publication

Meeting presentation

Other

Specify other products expected

Important time deadlines