Resource Request Form

The Resource Request Form provides a mechanism for investigators to request access to clinical specimens. Please note that this form is a mechanism by which the advisory committee can review requests and support appropriate projects. Submission of this request form does not guarantee access to specific resources. 

Please complete the questions and provide any restrictions pertinent to your request. If you have questions please contact Dr. Peter Clark (Peter.Clark@Vanderbilt.Edu)

Provide a descriptive project title
PI's first name
PI's last name
Provide academic position held by the PI
Provide the departmental division or institutional program in which this project will be completed
Type of Study
Select the description that best matches the study you wish to perform.
Provide a description of the materials for which access is requested. This should include a description of the material, inclusion and exclusion criteria for specimen selection and how much material is needed.
Administrative Requirements
Select the statement that reflects the IRB requirements for this project
Provide relevant background information that led to the design of this study.
Provide a brief hypothesis and/or expected results
Provide a description of the technical approach, the measurements made and statistical strategies implemented. Have the specific approach been used used successfully? If so, has the data been published (provide citation)?
Provide scientific and statistical justification for the resource requested. Please limit your description to less than 1 page.
If IRB approval has been obtained, please provide the title and IRB# along with the name of the PI of that IRB. If known, please provide the IRB approval type (Full, Expedited or Exempt)
Please provide the name and contact information of the pathologist associated with the project along with those of additional relevant collaborators and co-investigators.
Optional: Feel free to provide personnel descriptions.
Please note that access to patient specimens may require appropriate IRB approval and support from the Office of Research. Final approval of your request can be delayed until those applications are complete.