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Request Form for Biostatistics Support

Please complete the survey below to request biostatistics support and consultations through the Institute for Clinical and Translational Research (ICTR) at Baylor College of Medicine.

We kindly request at least one month notice for assistance with grant applications.

Data Capture

In general, we recommend REDCap for data capture.

Please consult Broman and Woo (2018) for data organization recommendations if data has already been collected in spreadsheets.

Karl W. Broman & Kara H. Woo (2018) Data Organization in Spreadsheets. The American Statistician, 72:1, 2-10, DOI:10.1080/00031305.2017.1375989

Date of Request (Y-M-D)

* must provide value

Y-M-D

Investigator First Name

Investigator Last Name

Investigator Email

Investigator Phone Number

Investigator Rank

Other: Investigator Rank

Are you currently a member of the Dan L. Duncan Comprehensive Cancer Center?

Yes

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DLDCCC program

Other DLDCCC Program

Are you a BCM Affiliate?

Yes

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BCM Department

Department of Medicine Section

Is this request associated with the LHB2 program?

Yes

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Department of Pediatrics Section

BCM Primary Location

Other BCM Location

Institution

Department

Is ______ ______ the PI?

Yes

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PI First Name

PI Last Name

Is the PI a BCM Affiliate?

Yes

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BCM Department

Department of Medicine Section

Is this request associated with the LHB2 program?

Yes

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Department of Pediatrics Section

Title of Project

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Project type

Retrospective chart review

Prospective observational study

Prospective clinical trial

Large national database (e.g., NIS, HCUP)

Survey

Animal or laboratory study

RNAseq or microarry analysis

Database development

Registry

Other

Brief description of project or research question

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Estimated Project Start Date (Y-M-D)

Y-M-D

Estimated Project End Date (Y-M-D)

Y-M-D

Deadline/Due Date (Y-M-D)

Y-M-D

Is this research effort part of an educational requirement for a Resident, Fellow, or other Learner?

Yes

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Is this project associated with MS/PhD thesis or dissertation work?

Yes

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Is the project currently funded?

Yes

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If yes, please provide the funding type:

BCM Internal/Intramural Funding

TCH Internal/Intramural Funding

Federal Sponsor

Industry Sponsor

Foundation

Federal Sponsor:

Industry Sponsor:

Foundation:

Funding Start Date (Y-M-D)

Y-M-D

Funding End Date (Y-M-D)

Y-M-D

If no, is this request for support for a grant application?

Yes

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Funding Agency/Sponsor

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Sponsor Due Date

* must provide value

Y-M-D

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