Clinical Material Agreement Intake Form

If your lab is receiving material for use in a clinical trial, please fill out this form.

* indicates required fields.

CONTACTS






MATERIAL




Will you modify the Material?

Is the Material commercially available for purchase?

Is the Material approved by the FDA for other uses?

Will the Material be used to further develop an invention that has been disclosed to Stanford's Office of Technology Licensing?

COMPLIANCE


Have you requested IRB review *




Is the Material, or will the Material be used with material that is (check all that apply):


RESEARCH





Select the funding source(s) for the trial (check all that apply):


Have any of the involved Stanford researchers received gift funds from the Provider?

Do any of the involved Stanford researchers have a financial relationship with the Provider? (Check all that apply)

Have all participating Stanford researchers who are currently identified, including postdocs, students and visiting scholars, signed Stanford’s Patent and Copyright Agreement (SU-18 or SU-18A)?


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: ico@stanford.edu