You must have JavaScript enabled to use this form. For departments or groups who would like research support from a Fellow of the Academy. Must be a Fellow, Member or Trainee of the Academy. *Need a minimum of 3 weeks to process request. Name: * Email: * Degree(s): Rank: Department: Role on Project: - None -Research/Project CoordinatorAdministrative AssistantMedical Resident or FellowStudentPrincipal InvestigatorCo-InvestigatorOther What is your Academy affiliation?: Fellow Member Trainee None Project Title: * Do you have project funding?: Yes No If yes, list the amount, granting agency, and grant number (if available): Is this a quality improvement/evaluation project?: Yes No Method(s): Qualitative Quantitative Mixed Method Are you looking for study design or biostatistical support?: Yes No I'm not sure What type of assistance do you need?: Study Design/Sample Size Statistical Analysis Plan (includes analysis and interpretation) Survey/questionnaire Assistance with conducting your own analysis What best describes this project: Preparation of grant application Manuscript preparation or revision Assistance with abstract, presentation, or report Setting up a study or survey Development of new statistical methods or tools Other Project Description: Target date for completion: * IRB Number (if applicable): Statistical support comes from the Center for Clinical & Translational Science. Do you agree to cite the CCTS grant in any publications generated from this research?: Yes No Support comes from the Academy of Health Science Educators. Do you agree to cite the Academy in any publications generated from this research?: Yes No Leave this field blank
