Department of Biostatistics, Bioinformatics, and Biomathematics Collaborative Project Request Form
This form should be used by Principal Investigators or their Designated Contact Person to provide information about their research project, including funding source.

PLEASE NOTE: The form must be completed and returned to the Department of Biostatistics before any work can be started.

Principal Investigator (PI) Name
Your answer
Principal Investigator (PI) Email address
Your answer
Principal Investigator (PI) Phone
Your answer
Affilliation
Required
If LCCC affiliated, please select a program
If non-LCCC, please enter your full affiliation, company name and address, etc.
Your answer
Designated Contact (Requestor): NAME & TITLE
For requestors other than Principal Investigator (PI), enter designated CONTACT NAME & TITLE. Otherwise, enter "See Above".
Your answer
Designated Contact (Requestor): EMAIL address
For requestors other than Principal Investigator (PI), enter designated CONTACT EMAIL. Otherwise, enter "See Above".
Your answer
Designated Contact (Requestor): PHONE
For requestors other than Principal Investigator (PI), enter designated CONTACT PHONE. Otherwise, enter "See Above".
Your answer
DBBB Faculty requested
In the dropdown menu select the name of the faculty with whom you would like to collaborate on this project. If you do not have a specific faculty in mind, select "No preference." Please note that the Department will try to accommodate your request, however, we reserve the right to assign a different faculty member to your project. This depends on the faculty members' availability, expertise, etc.
Next
Never submit passwords through Google Forms.
This form was created inside of Georgetown University. Report Abuse - Terms of Service - Additional Terms