Form 1 Access Request

ID}

Kaitlin Taylor •

NeuroBioBank
About

Home

Reseerchers •

Donors •

ReqLJes1s •

Images •

Fublications

Contact

Data Manager•

Admm

ff Home

Submit a Request for Tissue Samples
Plannin� the Requnt

I[

Completinc the Form

I

I

Tinue Nu,;!�

Planning Your Tissue Request
• If you are not sure precisely what tissue, tissue regions, or quantities are best for your

• The more restrictive �our subject characterlstlcs, the less likely a brain ban� villi haV€

research pmject, please st1 hmir a r�ject

eomr,lt>Tinf: lhr M-line fN[ur>:;t_

rh;irnctNi�tlr,; (r. e., PMlmnrtrm lntl'MII (PMI), �NA lntr,grit,' Numher {RIN], flfP rnn2;l'i

are necessary for your study to be valld.

• The Request: Form requires you to provide a d..taii..d rationnlc for l)numbN of subjcctg
requested,£) amount of tissue requested per subject, Md :J) number of brain regions

• If you ha� not p�rtormed a pilot otudy in human tissue, your first requatshould be for

requested. Please s:tnmural Grant, CooperatiV@Ag,..ement, Contnct or NIH Intramural

lluur.:h) •

I

Fundi1111 ln•titution Typ••
Private Industry (Commercial)

AwHdNumber

Funding Organization

Name or funding A1jlency •

II Specimen Shipping Information
=I Uses3me addres.as llstedabove

Please tomp{eu, o NE of the !Dllowing fields:*

Country•

CarrierAcrount Number

Add re•• 1 •

·OR-

17 We will send shlrment label
Address 2

Lab Contact Email

City•

Preferred Shippin; Carrier•

StatefProvince/Region •

Zip/Postal Code•

Shipping Notesc

II Requested Specimens
Specimen Replacements
The N�rubiolm,k m�y proviUe 1epl�cement �pedmen� {if �vailable) for any wedmeu� th�l are UenieU i11 yuur IXiginJI re(lue�l. Tu help in liel�ting �pprupriale 1epl.lcerr�nt.,, pl�a�
wmplele Ll,e lwo nelJs Leluw.

Provide the criteria that you would preff!r lo r your 5elf!cted specimens

lo poSSf!SS.

Inclusion Criteria •

For instance, list¥')ur p references for a,,;e range, PMI, RIN,

neuropathological finding;, such as IJraak staging, etc. If requesting control
specimens, please explain which parameters must be matche1 (e.g., age,
sex, etc.). Also state which criteria shou Id be followed more mk!ly and

which can be followed more loosely. Having less strict requirement!! will
allow for a v,iderrange of available specimens.

Provide th viteria that y,;,u would prli!fer for your •elected •11ecirmm5

lo '-!OT po,,...�,.

bclu!iion C r iteria*

Be sreclflc If yo:, hil\re rreferenc�s ae,,lnst m-mmblr:lltles (e-�, cancer,

drprM".lcn, �llh.�tnnr,:, nhll",f\ Ptr.). Al",ll -�tntr 1,;hir.h rri!Nln -.hn1, ld hi'
rollowcd more �trlctty nnd which cnn be followed more loo-;cly. Having Le-;;
strict requirements wlll a Ilow for a wider range of available specimens.

-

'-lass Ch�11ge forAmount Requested

Edil Re in N MH Oc!td AFile Typeapplication/pdfFile Modified2024-08-09File Created2024-08-09