Academic Consultation Request

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Your first name: *

Your last name: *

Your email address: *

You will be contacted via email for initial meeting scheduling purposes.

Your academic institution: *

This is the institution for which you are completing your research.

What is your role at this institution? *

Note: If you are a student, you are required to inform your chair, committee member, or other academic mentor that you are working with me. This will apply when your institution does not openly request that you work with a statistician, or already require that I sign an agreement in order to work with you.

Undergraduate Student

Master's Student

Doctoral Student

Postdoctoral or Research Staff

Faculty

Other:

Project title: *

Please provide a short description or "title" for your project.

What are you working on now with respect to your project? *

Proposal/methodology/design

Data collection

Data analysis

Interpretation of results

Other:

What is your research question(s), your PICOT question, or the main purpose of your study? *

Have you collected any data yet? If so, describe the data you have collected; if not, describe the data you think you might collect (if known). *

Deadline:

If there is a set deadline for you to complete your project, please include that deadline here.

YYYY

Data storage: May I store data files and other files I received from you in the following ways? *

Note that I make every effort to keep all material confidential and private. If you say "no" to all options, do not send data prior to our discussion, and we will determine our best options then.

Yes

On Microsoft OneDrive, a password-protected internet storage service (preferred)

On a USB drive or other portable storage device

On a password-protected computer connected to the internet

Please review the following policy regarding personally identifiable information. *

K. R. Love Quantitative Consulting and Collaboration (QCC) cannot receive or store personally identifying information from individuals included in research studies. This refers to information that may allow the identification of specific individuals, and includes names, addresses, telephone numbers, email addresses, social security numbers, etc. It is your responsibility to ensure that this information is removed from any and all data sent to me. I will do my best to delete such information if it is sent to me through an oversight, but cannot be responsible for storing this information.

I have read and agree to the above policy regarding personally identifiable information.

Required

Please review the following policy regarding IRB and other review board regulations. *

Some studies require the approval of an institutional review board (IRB) at one or more institutions (particularly those involving human subjects); other studies may require the approval of other regulatory boards. If your study requires the approval of such a regulatory board, it is your responsibility to ensure that the proper board(s) has been consulted and necessary approvals have been received. While I reserve the right to cease participation in any study that I believe has not received proper approvals, K. R. Love QCC cannot be responsible for obtaining and reviewing these approvals. It is also your responsibility to inform me if I am required to participate in a formal agreement with the study review board.

I have read and agree to the above policy regarding IRB and other review board regulations.

Required

Optional: Do you have any specific questions about working with me, or other information to include with your request?

Optional: How did you learn about me?

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