If your lab is sending out human material for research purposes, please fill out this form.
* indicates required fields.
Principal Investigator *
SU Lab Contact/Admin Name & E-mail *
Recipient Institution/ Company Name *
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 *
Industrial Affiliates Program
Federal contract(s) or grant(s)
Name the above funding source(s) for your research project
Advisory Board Member or Board of Directors
Ownership of stock or stock options
Attach the Word version of the agreement, if available. Do not have the PI sign the agreement until it has been reviewed by ICO:
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.