Statistical Consulting

Application Form

Department of Statistics
University of Connecticut
(Click here for MS Word document)

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For Office Use Only:
Date Received: _______________________________ File Number: ____________
Date/Supervisor: ______________________________ Hours: __________________
Date/Consultant: ______________________________ Hours: __________________
Date/Consultant: ______________________________ Hours: __________________
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For Applicant:
Name: (Last/First) _______________________________ Date: ___________________
Department: ____________________________________________________________
Mailing Address: ________________________________________________________
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Telephone: Office: ________________________ Home: _____________________
Fax: ______________________________
e-mail: ______________________________
Which is the best way to contact you? E-mail: _____ Office: _____ Home: _____
___ Faculty ___ Staff ___ Ph.D. Student ___ M.S. Student ___ Undergrad ___ Other
(Specify Other): ___________________________________
If Student, Major Advisor: ___________________________ Phone: __________________
Major Advisor campus mailing address (U-Box #): ________________________
List statistics courses taken and statistical computing experience (optional): _________________
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Stage of Research:
_______________________________ Design (no data collected yet)
_______________________________ Presently collecting data
_______________________________ Analysis (all data has been collected)
If design state is complete, was a statistician consulted for design? ___________________________
If so, give name(s): _________________________________________________________________
Expected completion date of project: ___________________________________________________
Estimated number of consulting hours needed this semester: ________________________________
The results of this research will probably be published as (check all that apply):
___ M.S. Thesis ___ Ph.D. Dissertation ___ Tech Report ___ Journal Article ___ Other
Is this research supported by a grant or contract? _________________________________________
If so, give details: _________________________________________________________________
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Give a brief description of your problem including the following:
Purpose:
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Description of variables to be measured:
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Research questions that you want to address using statistical methods:
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Statistical issues:
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Statistical software issues:
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If there are papers about previous studies of a similar nature which might aid us in helping you, please attach copies.

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Signature/Applicant/Date

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Major Advisor/Research Sponsor
(Signature required if you are a student.)