Expression of Interest for Material and/or Information from BCTB


Principal Investigator:	* (full name and title)
Institution:
Full Postal Address:	*
Post/Zip code:	*
Telephone:	* (Include international dialing code)
Fax:
Email:	*
Confirm Email:	*
Title of research project:	*
Proposed start date of project:	*
Is this a pilot project? (Definition of pilot project)

Brief abstract of project (not more than 200 words): * Word Counter:

Please list the number and type of samples you anticipate would be needed for your project i.e. blood ( type – serum, plasma, whole blood etc); formalin fixed tissue sections or cores; fresh frozen tissue; DNA/RNA (from blood); DNA/RNA from tissue, digital images of tumour sections, data only.

N.B. APPLICATIONS FOR FUNDING SHOULD NOT BE RELIANT ON ACCESS TO SAMPLES AND/OR INFORMATION FROM THE BCTB AS THIS CANNOT BE GUARANTEED. IF MATERIAL FROM THE BANK IS NECESSARY FOR A PROJECT TO GO AHEAD, THEN THE BANK MUST BE APPROACHED WELL IN ADVANCE OF THE GRANT APPLICATION AND A WRITTEN AGREEMENT ENTERED INTO. N.B. APPROVAL OF THE PROJECT BY A HUMAN RESEARCH ETHICS COMMITTEE IS ESSENTIAL BEFORE SPECIMENS AND/OR INFORMATION FROM THE BCTB IS RELEASED. APPLICANTS ARE STRONGLY ADVISED TO APPLY FOR ETHICAL APPROVAL WELL IN ADVANCE OF MAKING A FORMAL REQUEST FOR MATERIAL.

Version 1.1 EOI Form JEC 05/09/2008
Text boxes marked with * sign are mandatory.