If your lab is receiving material for use in a clinical trial, please fill out this form.
* indicates required fields.
Principal Investigator *
Lab Contact/Admin Name & E-mail *
Provider Contact Name & E-mail *
Describe the drug or device:
Will the Material be used in a clinical trial at Stanford with one or more other drugs/devices? If so, please provide the SPO # for the clinical trial:
Please provide IRB protocol #(s) : *
Upload IRB approval/exemption letter below:
Human stem cells, embryos, or oocytes (SCRO)
Radiologically hazardous (CRA/SMN)
rDNA non-exempt under NIH guidelines (APB)
Please provide protocol #(s) for the above selection(s) :
Who developed the Protocol?
Who is the Sponsor of the trial?
Federal contract(s) or grant(s)
Name the above funding source(s) for your trial:
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: firstname.lastname@example.org
Please skip. Do not fill this out.