[Please enter a short introduction]
* indicates required fields.
Principal Investigator *
Lab Contact/Admin Name & E-mail *
Collaborator Contact Name & E-mail *
Will you use the Collaborator's Material with other proprietary materials from companies and were agreements signed for the other materials? If so, what are the other materials and who provided them?
Human stem cell, embryos, or oocytes (SCRO)
Live vertebrate animals (APLAC)
Obtained from a living person (IRB)
Radiologically hazardous (CRA/SMN)
rDNA non-exempt under NIH guidelines (APB)
Infectious or Biohazardous (APB)
Please provide protocol #(s) for the above selection(s)
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
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.