If your lab is sending out human material for research purposes, please fill out this form.
* indicates required fields.
Principal Investigator *
Lab Contact/Admin Name & E-mail *
Recipient Name & E-mail *
Describe/list the human materials you wish to send out
Does the Material include personally identifiable information (PII) or personal health information (PHI) or other data about a living person? If so, please describe
Please provide IRB protocol #(s) : *
Upload IRB approval/exemption letter:
Please provide a short justification for the scientific value of the transfer *
Federal contract(s) or grant(s)
Name the above funding source(s) for your research project
Advisory Board or Board of Directors member
Ownership of stock or stock options
Your E-mail *
After you click “Submit Form” below, you will receive an e-mail confirmation. We will contact the Principal Investigator and individual(s) identified as the Lab Contact/Admin about next steps. For questions, please contact: email@example.com
Please skip. Do not fill this out.