PI First Name* must provide value
Principal Investigator (first name and middle initial)
PI Last Name* must provide value
PI Email Address* must provide value
PI Phone Number* must provide value
Provide the best contact number (including area code) to reach the PI or to leave a voicemail during business hours.
Today's Date* must provide value
Today Y-M-D
Are you the PI on the study? Yes
No
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Submitter First Name
Submitter Last Name
Submitter Email Address
Submitter Phone Number
Include Area Code
Administering Department* must provide value
AA-Unlisted department- please add name Applied Science Biological & Agricultural Engineering Biomedical Engineering CA&ES Dean's Office Center for Biophotonics Center for Mind and Brain Center for Musculoskeletal Health Center for Neuroscience Center for Population Biology Center for Precision Medicine Chicana/o Studies College of Biological Sciences- Dean's Office College of Engineering Dean's Office College of Letters and Science, Dean's Office Design Entomology/Nematology Environmental Science & Policy Evolution & Ecology Food Science & Technology Genome Center Graduate School of Management Human Ecology John Muir Institute of the Environment Linguistics Mechanical & Aerospace Engineering Microbiology & Molecular Genetics Molecular & Cellular Biology MPIC Neurobiology, Physiology & Behavior Nutrition Patient Care Services (PCS) Pharmacy Psychology School of Education School of Nursing Shriner's Children's Hospital SoM Alzheimer's Disease Center SoM Anesthesiology - Clinic Affairs SoM Anesthesiology & Pain Medicine SoM Biochemistry & Molecular Medicine SoM Cell Biology & Human Anatomy SoM Center for Health and Technology SoM Center for Health and the Environment SoM Center for Healthcare Policy & Research (ORU) SoM Center for Reducing Health Disparities SoM Center for Tissue Regeneration & Repair SoM Clinical and Translational Science Center SoM Dermatology SoM Emergency Medicine SoM Family & Community Medicine SoM Imaging Research Center SoM Institute for Population Health Improvement SoM Institute for Regenerative Cures SoM Internal Medicine-Administration SoM Internal Medicine-Cardiovascular Medicine SoM Internal Medicine-Clinical Nutrition SoM Internal Medicine-Endocrinology, Metabolism, and Diabetes SoM Internal Medicine-Gastroenterology and Hepatology SoM Internal Medicine-General Medicine, Geriatrics, and Bioethics SoM Internal Medicine-Hematology and Oncology SoM Internal Medicine-Infectious Diseases SoM Internal Medicine-Kidney Transplant SoM Internal Medicine-Liver Transplant SoM Internal Medicine-Nephrology SoM Internal Medicine-Pulmonary, Critical Care, and Sleep Medicine SoM Internal Medicine-Rheumatology, Allergy, and Clinical Immunology SoM Medical Microbiology and Immunology SoM MIND Institute SoM Neurological Surgery SoM Neurology SoM Obstetrics & Gynecology SoM Office of Medical Education SoM Ophthalmology SoM Orthopaedic Research Lab SoM Orthopaedic Surgery SoM Otolaryngology SoM Pathology SoM Pediatrics SoM Pharmacology SoM Physical Medicine and Rehabilitation SoM Physiology & Membrane Biology SoM Psychiatry & Behavioral Science SoM Public Health Sciences SoM Radiation Oncology SoM Radiology SoM School of Medicine- Dean's Office SoM Surgery SoM UC Davis Comprehensive Cancer Center SoM Urology VM Anatomy, Physiology & Cell Biology VM California Animal Health and Food Safety Laboratory System (CAHFS) VM California National Primate Research Center VM Center for Comparative Medicine VM Dean's Office VM Medicine & Epidemiology VM Molecular Biosciences VM Pathology, Microbiology & Immunology VM Population Health & Reproduction VM Surgical & Radiological Sciences VM Teaching Hospital VM Western Institute for Food Safety & Security ZZ-Other
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What is the administering department?
Identify department responsible for administering project
Other department name
Please select all of the services you wish to request using the list on the right. If you do not find the service you need or are uncertain about the choices offered, leave this field unchecked and proceed to the next question. Biostatistics Support
Clinical or Research Nursing Support for a Protocol (CCRC)
Clinical Trials Office Services
Community Engaged Research Support
Health Equity Resources
REDCap Database Support
Use this space to describe your research need or project. We will contact you to discuss how we can help.
Project Title/Name* must provide value
Provide the full project or study title. If this is not a research project, enter N/A and describe your project above.
Center Affiliation* must provide value
Alzheimer's Disease Center Center for Health Care Policy Research Comprehensive Cancer Center Environmental Health Sciences Center MIND Institute CNPRC-Primate Center None of the Above
Type of Project* must provide value
Data Collection and Management Guidance Data Safety Monitoring Board (DSMB) Grant Proposal Assistance Pre-Clinical Study Interventional Study - Clinical Observational Study - Prospective Observational Study - Retrospective General Inquiry or Other
Click here to get information on weekly biostatistical office hours What service(s) are you requesting?* must provide value
Data Collection and Data Management Guidance
Data Safety and Monitoring Board (DSMB) Participation
Grant Proposal Preparation
IRB Protocol Development/ Study Design
Sample Size/ Power Calculations
Statistical Advice
Statistical Analysis and Interpretation of Data
Statistical Analysis Plans
Is there funding to support the statistical analysis?* must provide value
Yes
No
Preferred Statistician * must provide value
No Preference Susan Alber Heejung Bang Shuai Chen Blythe P Durbin-Johnson Sili Fan Jeff Fine Yueju (Judy) Li Sirpreet (Shawn) Padda Matt Ponzini David Rocke Sandra Taylor Machelle Wilson Nuen Tsang (Matt) Yang
Is there a deadline?* must provide value
Yes
No
Deadline* must provide value
Today Y-M-D
What is due?* must provide value
Grant Proposal IRB Protocol Abstract or Poster Paper Other
What other item is due?
Does your project include a human or animal subject protocol?* must provide value
Yes
No
Protocol Type* must provide value
Human Subjects
Animal Subjects
Please upload the approved or current version of your protocol(s)* must provide value
UC Davis Protocol #
Is this study part of a multisite study/trial?* must provide value
Yes
No
Study Acronym
List the study acronym if one exists
Study Categories* must provide value
Clinical Trial
Social/Behavioral
Native Americans
Diversity, Equity, and Inclusion
Health Disparities (HD)
Pediatrics
Opioids
HIV/AIDS
COVID
None of the Above
Check all that applies to the above referenced study. An NIH defined Clinical Trial is a research study in which one or more human subjects are prospectively assigned to one or more interventions (which may include placebo or other control) to evaluate the effects of those interventions on health-related biomedical or behavioral outcomes.
Is funding associated with this project/study/trial?* must provide value
Yes
No
Funding Source* must provide value
NIH-National Institutes of Health (including NCI) USDA-US Department of Agriculture CDC-Centers for Disease Control FDA-Food & Drug Administration DOD-Department of Defense VA-Veterans Affairs DOE-Department of Energy Department of Education NSF-National Science Foundation FEMA-Federal Emergency Management Agency Other Federal Industry Funded Other Non-Federal Funding Departmental Funding
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Other Federal Funding Source
Other Non-Federal Funding Source
Company Name
Contract or Grant Number
If available
KFS Chart and Account Number
Account format= S-CTSC103
Financial Point of Contact (POC)
Financial POC Email
Requested Start Date
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