Investigator name
* must provide value
Investigator email
* must provide value
Academic title
* must provide value
Resident Clinical Fellow Postdoctoral Fellow Instructor Assistant Professor Associate Professor Professor Other
Please state your academic title if not listed above
Investigator department/division
* must provide value
Where did you hear about our service?
* must provide value
DOM email CTEU email Mongan email CTEU website My division chief Referred by other investigators Referred by Biostatistics core Word of mouth Other
Please describe where you heard about our service
What service do you need?
* must provide value
Epidemiological data analysis or study design
Biobanking/repository
Check all that apply
Epidemiological study design
Study design and/or patient selection from Electronic Health Records/ RPDR
Sample size estimates
Protocol development
Data analysis plan
Other
Check all that apply
Please describe your study design request if not included above:
IRB overview consult
IRB materials preparation/maintenance
Other
Check all that apply
Please describe your study start up request if not included above:
Generation of dataset using EHR, EPIC or biobank portal (cohorts/case-control/cross-sectional)
Epidemiological or pharmaco-epidemiology data analysis
Analysis of genomic/ metabolomic/ epigenomic or other omic data sets
Causal inference/ Mendelian randomization analyses
Bioinformatics support
Analytic plans, sample size or power calculations for grant proposals/manuscripts
Statistical programming (R/SAS/Stata/Python) and cluster computing support (ErisOne/Channing/FAS)
Training in epidemiologic/ statistical methods
Programming review/ debugging
Other
Check all that apply
Please describe your analytics request if not included above:
Biorepository study design
Biorepository/sample collection consultation
IRB protocol review
Other
Check all that apply
Please describe your study design request if not included above:
Do you need lab space or lab tech support to process samples?
Yes
No
Not sure
What type of sample processing support will you need?
Lab space only (for investigators who have staff to process samples)
Full service processing (for investigators who need a biobank lab tech to process samples)
Not sure
What type of biospecimen will be processed?
Blood
Stool
Urine
Saliva
Tissue
Other
Not sure
Check all that apply
Please describe your biospecimen(s) if not included above
What type of sample processing do you need?
Aliquoting
Other
Not sure
Please describe the type of processing if not included above
Do you need space to store your samples in the CTEU EPICORE?
Yes
No
Not sure
Select which storage temperature you require
-80
-20
Not sure
Check all that apply
How long do you anticipate needing to store your samples with the CTEU EPICORE?
Less than 6 months
6 months to 1 year
1 to 5 years
Greater than 5 years
Unknown/indefinite
What method of sample tracking do you plan to use?
REDCap
Freezerworks
Other
Not sure
Please describe what method you intend to use
Do you need support with sample collection?
Yes
No
Not sure
Please explain your sample collection needs
How often do you anticipate needing to retrieve your samples?
This can be provided on a timeline basis (ie every 6 months) or a progress basis (ie every 20 samples). If unsure, please write "not sure".
Will you need assistance shipping samples?
Yes
No
Not sure
How many shipment batches do you anticipate?
If unsure, please write "not sure".
How often do you anticipate needing to ship samples?
This can be provided on a timeline basis (ie every 6 months) or a progress basis (ie every 20 samples). If unsure, please write "not sure".
Do you have funding for your project?
Currently funded grant
Sundry/departmental funds
Pilot project grant
Pending grant proposal (submitted, but not yet awarded)
None
Other
If this is for an upcoming grant application please check "Other" and denote the due date of the proposal and whether a letter of support will be required.
Please describe your funding source if not included above
Please provide a brief overview of your project and the services you're looking for, specifically noting how long sample collection (i.e. duration of recruitment) is expected to take and how often samples will be brought to the biobank (i.e. recruitment pace and study visit frequency).
* must provide value
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