Investigator's Name:

Rank:

Department and School:

Phone Number:

Email Address:

Title of Project:

Brief description of the research question and study plan for which you seek biostatistical assistance:

Proposed utilization of GCRC resources:

Assistance in designing a study and writing a clinical research grant application (including sample size and power), for which you will apply for use of GCRC resources

Biostatistical consultation for an existing funded grant, which utilizes GCRC resources

Data analysis consultation (but not necessarily statistical programming)

Assistance with presentation of results, including manuscript preparation

Other (specify)