Biostats Inquiry Form

Service Request Form:

Please fill out this form to request REST Services
Full Name*

First NameLast Name
Phone Number
E-mail*
example@example.com
Are you an:

High School StudentCollege/University StudentAcademic Affiliate (Professor, Researcher, University faculty/staff)Community MemberCompany or Organization
Year in School during Academic Year 2023-2024

High School StudentCollege FreshmanCollege SophomoreCollege JuniorCollege SeniorGraduate Student
Are you currently an NEIU student?

YesNo
The Industry or Discipline That Best Describes Me Is
Are you placing this request on behalf of or is this project affiliated with an organization or company? If so, please list the name.
Company or Organization Name
All our services are provided for free. Please check the analysis type/types that you are requesting:
prevnext( X )
Grant Proposal
$ Free Quantity



Manuscript for Publication
$ Free Quantity



Thesis/Capstone Project
$ Free Quantity



Research Project
$ Free Quantity



Other- Not Listed
$ Free Quantity



Total

$0.00
Name of Your Research Project:*
Please create a distinct & defining title for your project (Max 40 Characters)
Briefly describe the type of work that you are requesting from the Biostats Core*
Is your project funded? If so, please indicate the funding mechanism and source:*
Does your project require IRB approval?*

YesNo
Is your project IRB approved?

YesNoThe IRB approval is in progress
Please indicate 3 dates and times below that you are available to meet with the team concerning your project.
1. Select Date and Time*

MonthDayYear
Date
Hour MinutesAM/PM Option
2. Select Date and Time*

MonthDayYear
Date
Hour MinutesAM/PM Option
3. Select Date and Time*

MonthDayYear
Date
Hour MinutesAM/PM Option
How did you hear about us?*
Should be Empty:

Service Request Form:

Please indicate 3 dates and times below that you are available to meet with the team concerning your project.