Resource Request Form | Clinical Research Information and Specimen Services (C.R.I.S.S.)

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)

Title

Provide a descriptive project title

First Name

PI's first name

Last Name

PI's last name

Academic Position

Provide academic position held by the PI

Institution

Department

Division or Program

Provide the departmental division or institutional program in which this project will be completed

E-Mail

Phone Number

Type of Study

This is an investigator-initiated, academic study performed at Vanderbilt.

This is an investigator-initated, academic study performed at Vanderbilt and other collaborating academic institutions.

This is an investigator-initatied, academic study performed with industry support.

This is an industry-sponsored study performed with the assistance of a Vanderbilt investigator.

Select the description that best matches the study you wish to perform.

Requested Materials

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

IRB approval is not required for this study (please indicate the reason below)

an IRB application has been submitted or was approved (please provide the application title and IRB# below)

an IRB application will be submitted in the near future (please note that project approval might be contingent on IRB approval)

Further assistance is needed from the tissue committee to determine the need for IRB approval

Select the statement that reflects the IRB requirements for this project

Background

Provide relevant background information that led to the design of this study.

Hypothesis

Provide a brief hypothesis and/or expected results

Technical Approach

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)?

Justification

Provide scientific and statistical justification for the resource requested. Please limit your description to less than 1 page.

IRB Approval

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)

Co-Investigators

Please provide the name and contact information of the pathologist associated with the project along with those of additional relevant collaborators and co-investigators.

Personnel Description

Optional: Feel free to provide personnel descriptions.

Additional information or questions

Note

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.