If your lab is receiving data or data sets, please fill out this form.
If the provider is a non-profit or governmental organization, contact the Office of Sponsored Research: email@example.com
* indicates required fields.
Principal Investigator *
Lab Contact/Admin Name & E-mail *
Provider Contact Name & E-mail *
Is the Data considered sensitive or does it contain confidential information?
Describe where the Data will be stored:
Does the Data include meta data? If so, describe:
What security measures will be used to protect the Data?
Will the Data be combined with data from other sources? If so, what are these sources and was an agreement signed for the other data?
Upload Data Use Agreeement:
Please provide IRB protocol #(s) :
Federal contract(s) or grant(s)
Specify the name(s) of 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: firstname.lastname@example.org
Please skip. Do not fill this out.