CNICS Specimen Webform
  1. Use this webform to submit feasibility requests for CNICS specimens. Once your request is reviewed, someone from CNICS will contact you. Please provide accurate contact information.
  2. Lead Investigator:
  3. First Name(*)
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  4. Last Name or Surname(*)
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  5. Institution(*)
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  6. Email Address(*)
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  7. Phone Number(*)
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  8. Other Investigator 1:
  9. 1 First Name
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  10. 1 Last Name or Surname
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  11. 1 Institution
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  12. Other Investigator 2:
  13. 2 First Name
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  14. 2 Last Name or Surname
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  15. 2 Institution
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  16. Other Investigator 3:
  17. 3 First Name
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  18. 3 Last Name or Surname
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  19. 3 Institution
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  20. Brief Background of Project
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  21. Project Title
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  22. Number and type of specimens desired
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  23. Laboratory where specimens will be sent
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  24. Laboratory Type(*)
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  25. Laboratory Shipping Address
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  26. Receiving Laboratory Contact Person:
  27. First Name
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  28. Last or Surname
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  29. Email Address
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  30. Phone Number
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  31. If suitable specimens can be identified for your project, you will be asked for your preferred overnight shipping carrier with account number. Investigators are expected to pay for the shipment of CNICS specimens.
  32. Upload a copy of the PIs CV(*)
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  33. Upload a copy of the IRB approval for this study
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  34. Please type in the following characters:(*)
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