Please let us know how we can help you:
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I would like to submit a request for collaboration
I am a CBHDS team member hosting a walk-in session
First Name
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Last Name
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Today's Date
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Today M-D-Y
E-mail Address
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Preferred Method of Communication
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Email
Phone
Primary Affiliation
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Fralin Biomedical Research Institute
Virginia Tech Carilion School of Medicine
Virginia-Maryland College of Veterinary Medicine
Carilion Clinic
Other Virginia Tech affiliation
Other Non-Virginia Tech affiliation
Are you affiliated with the Fralin Life Sciences Institute (FLSI)?
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Yes
No
Fralin Life Sciences Institute - Research Center
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Global Change Center (GCC) Center for Coastal Studies (Coastal@VT) Translational Plan Sciences Center (TPS) Center for Emerging, Zoonotic, and Arthopod-borne Pathogens (CeZAP) Other
If 'Other' research center/group at Fralin Life Sciences Institute, please specify:
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If 'Other' research center/group at Fralin Life Sciences Institute, in which building do you reside?
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Steger Hall Fralin Hall Integrated Life Sciences Building Life Sciences I Latham Hall I do not reside in any of these buildings
Please specify the name of the building where you are located:
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Fralin Biomedical Research Institute - Center/Unit
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Addiction Recovery Research Center Cancer Research Group Center for Glial Biology in Health, Disease, and Cancer Center for Vascular and Heart Research Center for Human Neuroscience Research Center for Neurobiology Research Center for Health Behaviors Research National Pediatric Rehabilitation Resource Center Neuromotor Research Clinic Virginia Tech Schiffert Health Center Molecular Diagnostics Lab Other
If 'Other' research center/unit at Fralin Biomedical Research Institute, please specify:
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Virginia-Maryland College of Veterinary Medicine - Department
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Biomedical Sciences & Pathobiology Small Animal Clinical Sciences Large Animal Clinical Sciences Population Health Sciences Veterinary Medicine at the University of Maryland
Carilion Clinic - Department
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Emergency Medicine Pediatrics Family & Community Medicine Orthopaedics Radiology Surgery Medicine Psychiatry and Behavioral Health Obstetrics & Gynecology Other
If 'Other' department at Carilion Clinic, please specify:
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Virginia Tech - College
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College of Agriculture and Life Sciences College of Architecture and Urban Studies Pamplin College of Business College of Engineering College of Liberal Arts and Human Sciences College of Natural Resources and Environment College of Science Corps of Cadets Honors College Other
College of Agriculture and Life Sciences - Department
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Agricultural and Applied Economics Agricultural, Leadership, and Community Education Agricultural Technology Program Animal and Poultry Sciences Biochemistry Biological Systems Engineering Crop and Soil Environmental Sciences Dairy Science Entomology Food Sciences and Technology Horticulture Human Nutrition, Foods, and Exercise Plant Pathology, Physiology, and Weed Science
College of Architecture and Urban Studies - School
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School of Architecture & Design Myers-Lawson School of Construction School of Public and International Affairs School of Visual Arts
School of Architecture & Design - Department
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Architecture Industrial Design Landscape Architecture Interior Design
Myers-Lawson School of Construction - Department
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Building Construction Construction Engineering and Management
School of Public and International Affairs - Department
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Public Administration and Policy Urban Affairs and Planning Government and International Affairs
School of Visual Arts - Department
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Graphic Design (VCD) Creative Technologies Studio Art Art History
Pamplin College of Business - Department/Program
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Accounting and Information Systems Business Information Technology Finance, Insurance, and Business Law Hospitality and Tourism Management Management Marketing Real Estate MBA Masters Business Analytics
College of Engineering - Department
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Aerospace and Ocean Engineering Biological Systems Engineering Biomedical Engineering and Mechanics Chemical Engineering Civil and Environmental Engineering Computer Science Electrical and Computer Engineering Engineering Education Industrial and Systems Engineering Materials Science and Engineering Mechanical Engineering Mining and Minerals Engineering
College of Liberal Arts and Human Sciences - Department/School
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Alliance for Social, Political, Ethical, and Cultural Thought Apparel, Housing, and Resource Management Communication English History Human Development and Family Science Modern and Classical Languages and Literatures Philosophy Political Science Religion and Culture Science, Technology, and Society Sociology Reserve Officer Training Corps Education School of Performing Arts
College of Natural Resources and Environment - Department
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Fish and Wildlife Conservation Forest Resources and Environmental Conservation Geography Sustainable Biomaterials Center for Leadership in Global Sustainability
College of Science - Department/School
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Academy of Integrated Science Biochemistry Biological Sciences Chemistry Computational Modeling & Data Analytics Economics Geosciences Mathematics Microbiology Nanoscience School of Neuroscience Physics Psychology Statistics Systems Biology
School of Performing Arts - Program
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Music Theatre Cinema
If 'Other' college at Virginia Tech, please specify:
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If 'Other Non-Virginia Tech' affiliation, please specify:
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VTC School of Medicine Position
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Clinical Faculty Non-Clinical Faculty (Tenure Track, Research, Practice, etc) Administrative Faculty (Dean, VP, Director, etc) Staff Graduate Student (Master's or Ph.D. Program) Medical Student (M.D. Program) M.D. Dual Degree Program (e.g., MD/PhD, MD/MPH) Post-Doc/Resident/Fellow Other
If 'Other' VTC School of Medicine position, please specify:
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VTC School of Medicine - Department
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Basic Science Education Emergency Medicine Family and Community Medicine Internal Medicine Interprofessionalism Obstetrics and Gynecology Orthopaedic Surgery Pediatrics Psychiatry and Behavioral Medicine Radiology Surgery Health Systems and Implementation Science
VTC School of Medicine - M.D. Student Year of Study
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Year 1 Year 2 Year 3 Year 4
Position
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Clinical Faculty Non-Clinical Faculty (Tenure Track, Research, Practice, etc) Administrative Faculty (Dean, VP, Director, etc) Staff Undergraduate Student Graduate Student Post-Doc/Resident/Fellow Other
If 'Other' position, please specify:
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If you are a student, please specify the academic program you are currently enrolled in (e.g., CMDA, TBMH).
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If you are an M.D. student co-enrolled in another graduate degree program, please specify that degree program here.
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If student, please specify the name of your faculty advisor:
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Are you an iTHRIV Scholar?
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Yes
No
Are you affiliated with iTHRIV in a different way (e.g., iTHRIV Community Partner, funded by an iTHRIV Pilot grant, other type of affiliation, etc.)?
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Yes
No
Please describe your iTHRIV affiliation:
Project Title
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Brief Project Description
Is this work in support of an upcoming deadline (abstract deadline, manuscript submission deadline, grant proposal deadline, etc) ?
Yes
No
What is the deadline for your final deliverable (abstract, manuscript, grant proposal, etc) ?
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Today M-D-Y
Please specify the type of support needed (select ALL that apply)
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Statistical or data management consultation
Database design and building
Data collection/management
Randomization scheme generation
Creating a statistical analysis plan
Power analysis/sample size calculation for a grant submission
Statistical methods section for a grant submission
Analysis of existing data
Manuscript preparation
Assistance responding to reviewer comments for a manuscript
Conference abstract submission
Conference poster/presentation
DSMB report generation
Guest lecture request
Infrastructure building
Other
If 'Other' type of support needed, please specify:
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How did you hear about CBHDS? (select ALL that apply)
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Returning researcher
Email notification
CBHDS website
Statistics department website
Referred by another student
Referred by my professor
Referred by a faculty colleague
Other
Please provide details about the student, professor or faculty colleague who referred you to CBHDS:
If 'Other', please specify how you heard about us:
If you experience any problems with this request form or would like to provide some feedback, please send an email to:
Alicia Lozano
alozano@vt.edu
Request Completed (Please leave blank for CBHDS biostatisticians to fill in)
Yes
No
Name of CBHDS Team Member Holding Walk-in Hours
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Ian Crandell
Alicia Lozano
Jennifer West
Wenyan Ji
Monica Ahrens
Day of the Week
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Monday
Wednesday
Time of Walk-in Encounter (HH:MM)
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Now H:M
Is this in support of a funded research project?
Yes
No
A project is considered "funded" if the CBHDS is currently receiving funding for work on the project.
Question(s) asked during walk-in session:
Service(s) provided during walk-in session (check all that apply):
Database/Data collection
Study design
Analysis question
REDCap/Qualtrics/TriNetX
Sample size/power question
Software question
Other
If 'Other' service(s) provided, please specify here.
What is the status of this walk-in encounter?
Complete
Incomplete
If walk-in encounter is 'Incomplete', please provide details (e.g., referral to engineering or computer science).