Biostatistician Request Form

Request Number (Internal use Only):
Principal Investigator:*
PI Job Title
Campus Location:
Phone Number:
Research Administrative Officer:
Protocol Title:
Investigator participation: are you the author of the study?
If no, are you a co-PI or did you have significant input into study design or development?
Who is the study Sponsor?
Please indicate project type: Grant Submission
Study Design
Manuscript Production
If other, please specify:
Does any part of this study receive sponsored funding?
Any deadlines associated with this project? If so, please indicate date:
Date needed to be returned to Principal Investigator (please allow at least 4 weeks):
Expected amount of time for Biostatician to complete request:
Date Request Submitted:
Requestor's Signature (type or electronic):
I recognize that authorship is independent of funding, and I will generally follow criteria for authorship described at:
Date Request Closed (Internal Use Only):
Email of the person completing this form
*required field

Read the criteria for authorship at: