CNICS Specimen Webform

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.

Lead Investigator:

First Name(*)
Invalid Input

Last Name or Surname(*)
Invalid Input

Institution(*)
Invalid Input

Email Address(*)
Invalid Input

Phone Number(*)
Invalid Input

Other Investigator 1:

1 First Name
Invalid Input

1 Last Name or Surname
Invalid Input

1 Institution
Invalid Input

Other Investigator 2:

2 First Name
Invalid Input

2 Last Name or Surname
Invalid Input

2 Institution
Invalid Input

Other Investigator 3:

3 First Name
Invalid Input

3 Last Name or Surname
Invalid Input

3 Institution
Invalid Input

Brief Background of Project
Invalid Input

Project Title
Invalid Input

Number and type of specimens desired
Invalid Input

Laboratory where specimens will be sent
Invalid Input

Laboratory Type(*)
Invalid Input

Laboratory Shipping Address
Invalid Input

Receiving Laboratory Contact Person:

First Name
Invalid Input

Last or Surname
Invalid Input

Email Address
Invalid Input

Phone Number
Invalid Input

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.

Please type in the following characters:(*)
Invalid Input