UCSF - Clinical and Translational Science Institute

BREAD Service Request

The Biostatistics, Research Ethics, And Design Program provides consultation in the areas of study design and implementation, ethical and biostatistical issues, and data management.

If you are a UCSF researcher or a CTSI affiliate, you can request a consultation by completing the form below. Fields marked with an asterisk are required. If you have not been contacted by a member of the BREAD consulting team within three business days of submitting your request, email us.

Important: all publications resulting from the utilization of CTSI resources are required to credit the CTSI grant by including the NIH Funding acknowledgement.

Information about you

First Name*

Last Name*

Email*

Phone

Mailbox

The information we're requesting below helps us understand your needs better and captures who we are serving. Thank you in advance for completing and submitting this form.

Degrees (check all that apply)

MD PhD MCR/MPH/MS DDS RN PharmD Other

Faculty Rank

Faculty Series

Non-faculty Title

If other, please specify

School (primary)*

Campus

If other, please specify

Department (primary affiliation)*

If other, please specify

Division or research unit, if applicable

Time spent on research

Time spent in clinic

Primary research type*

If other, please specify

Gender

Ethnicity

Race

Project Information

Title/Topic*

One word nickname for your project*

PI same as above* If you are not the PI, complete PI information below (required).

PI First Name*

PI Last Name*

PI Email*

What are your primary goals for this consultation? (please be brief)

Type of Study (check one)

Clinical Trial, Single Center
Clinical Trial, Multiple Centers
Diagnostic Test Study
Pharmacokinetics Study

Other Observational Study (case-control, cohort, cross-sectional, etc)
Health Policy Studies: decision analysis; utilization and/or cost; cost-effectiveness;
systematic review; knowledge-beliefs-attitudes

Other/Unsure:

Stage of Project (check one)

Planning study
Applying for funding
Implementing funded study
Analyzing data that has already been collected
Responding to reviews
Other/Unsure:

Describe Timeline (grant due date, etc)

Types of Assistance Required *Check at least one

Primary Focus of Request
If you requested assistance in more than one category, which area would you like help with first?

Study Design and Implementation
Grant Review
Scientific Review of CHR Protocols
Data and Safety Monitoring
Ethical Issues
Biostatistical Issues
Data Management Issues
Not applicable, or doesn't matter

Please check all that may apply to you:

I am writing a grant and plan to include a biostatistician as a co-investigator with at least 10%
support, and am thus eligible for 20 additional free hours of BREAD Biostatistics consultation
I anticipate requiring additional services beyond what BREAD provides free of charge (see our
Recharge Policy). Here is my financial information, to the best of my knowledge:

Fund Number (5 digits)

DPA (6 digits)

Fund Year, if applicable (2 digits)

Program Code (optional, 5 characters)

Charging information valid through mm/dd/yyyy

Optional note to appear on invoice

Contact Information for Financial Analyst:
Name*

Mailbox

Phone

Comments

Please note that no charges will be posted to this fund until after the initial consultation, during which anticipated charges will be discussed with the consultant. Also, no additional services will be provided until fund information is verified.

Other Information

How did you hear about the BREAD services?

Comments

In clicking "Submit Request" you agree to provide feedback and a short evaluation of our services, providing the titles of manuscripts or grants resulting from your BREAD consultation(s) when requested.