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Data Analysis Request Form

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Date:
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First Name:(*)
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Last Name:(*)
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Title/Position:
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Requesting Organization (ex; MSM,TU,UAB):(*)
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Department:
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Phone:(*)
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E-mail Address:(*)
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New Study:

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Ongoing Study:

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Pilot Study:

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Funding Source (if available):
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Grant Number (if available):
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Study Title:
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Type of Request (Check all that apply):

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For "Others", please specify:(*)
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Biostatistics/Bioinformatics Faculty Contact:(*)
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Synopsis of the request:
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Research Question:
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Upload a file with details including Research Methodology, Analysis Plan, and more (if available):
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(*)
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