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Alabama Brain Collection Tissue Request

General Information

Project Title:

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Principal Investigator (PI)

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PI Information

PI's Institutional Affiliation

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Mailing Address

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PI's Email Address

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PI's Phone Number:

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Briefly describe the rationale of the study, the hypotheses that will be tested, and the goals for the study.

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Briefly describe preliminary studies and assurances that the techniques you propose to use will work in postmortem human tissue.

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Clinical Characteristics

DSM Diagnosis

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If other, please specify

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Medication Subgrouping

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Sample Demographics

Gender

Male

Female

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Age

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Race

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Pacific Islander

White

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PMI

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Drug History

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Other Information

Identify the funding source for the project or the projected funding source if tissue is needed for a pilot study.

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How much tissue is needed (Size of block, sections, etc.)

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Method of tissue preservation(*)

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Please upload a diagram of the brain region(s) to be studied.

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Request Submission

Once you submit your request, you will be notified about the decision in a timely fashion. Please note that the principal investigator is responsible for tissue processing and courier charges. If you are a UAB scientists, you will need to submit a signed Collaboration Agreement. If you are a scientist outside of UAB, we will have to exexute a Material Transfer Agreement (which acts in lieu of the Collaboration Agreement).

(*)

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Submit

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Alabama Brain Collection Tissue Request