The Nun Study Materials Request

Nun Study Materials Request Form

Request date

Research Project Title

250 character limit including spaces

Check any of the boxes below if any of the investigators listed on the application are from:

South Texas Alzheimer's Center (STAC)

Glenn Biggs Institute for Alzheimer's and Neurodegenerative Disease Research

UT Health San Antonio

Requesting Investigator Information

Name

Last

First

Email

Phone

Position

Institution

Contact Investigator Information

Same as lead investigator

Alternative Contact

Skip this section if the contact investigator is the same as the lead investigator.

Name

First

Last

Email

Phone

The purpose of this application is to determine whether the proposed project is feasible and within the goals of the Nun Study/Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases. To fulfill this, we ask applicants to provide a short overview of their research question, aims, and analysis plan. To avoid delays in accessing information or samples, be sure to obtain permission from your institutional IRB before submitting this form.

Which cohort are you requesting samples from?

Nun Study

HAAS (Honolulu Asia-Aging Study)

What type of dataset will your project require?
Please note that we reserve the right to contact your IRB and confirm any approvals/documents we receive.

Please visit Johns Hopkins for more information about identifiers.

Prior to data and/or sample disbursement, we must receive an exempt review from the IRB, as well as a Waiver of HIPPA authorization.

A data set with limited identifiers and/or biological samples. For example, dates, city of birth, complete zip code, etc.

A data set with identifiers and/or biological samples. For example, names, contract information, identifiable numbers (e.g. MRN, SSN), biometric identifiers, etc.

Have you obtained IRB approval for your research plan?

Yes

No

Note: A DUA and/or MTA initiated by your institution is required prior to receipt of samples and/or information. *

If yes, have you obtained a data use agreement (DUA) or material transfer agreement (MTA) for this project? Note: If you are a researcher outside of STAC, a DUA, and/or MTA initiated by your institution is required prior to receipt of samples and/or information.

Yes

No

If no, please provide the anticipated date of your DUA/MTA (MM/DD/YYYY).

Project description including objectives and a brief description of importance/novelty/contribution:

200 word maximum

Methods including type of experiments e.g., IHC, WB, single cell, ...:

200 words maximum

* Please note that if a novel technique is being used, either provide proof of concept or request limited number of samples for a pilot study. These will be provided from larger regions like the parietal.

I will provide proof of concept

I will be requesting a limited number of samples from larger regions like the cortex

If you will be providing proof of concept, please complete the next two questions:

Provide Supporting Evidence: Present any preliminary data, literature references, or pilot studies that support the feasibility and effectiveness of the new method. This could include results from experiments conducted in-house or findings reported in published studies:

200 words maximum

Provide Supporting Evidence: Present any literature references:

No maximum

Address Potential Concerns: Anticipate and address any concerns or questions that may arise regarding the feasibility, reliability, or applicability of the new method. Provide explanations or solutions to mitigate these concerns:

150 words maximum

Sample Requests

Sample Set Information

Inclusion criteria

Exclusion criteria

Experimental groups

Number of samples from each group

Clinicopathologic information requested (including demographics, disease stage/grade, ...):

Brain Sample Request

Biospecimen sample information (select all that apply):

Unstained Samples

Digital Images

Biospecimen sample information (select all that apply):
Unstained Slides

Digital Images

Stained slides request

H/E

Bielschowsky

Gallyas

Number of samples needed for DNA/RNA:

For frozen tissue: weight of sample from each region (g)

Biofluid Sample Request

Biofluid type

Please provide the number of samples and volume per sample (uL) for each biofluid type you are requesting.

Please provide the expected completion date of this project.
Note, all users must cite the Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases as the data source and our funding sources, such as South Texas Alzheimer's Disease Research Center.
We will send quarterly reminders to all listed study staff.

MM/DD/YYYY

Are you generating new data?

Yes

No

Unsure

By checking this box, you agree to share with the Biggs Institute if requested.

By checking this box, you understand that you will need to provide any relevant documents (e.g. IRB approval document, DUA/MTA, details for proof of concepts, etc.) for your application to be reviewed. Documents can be sent to our lab via email to flanaganlab@uthscsa.edu. A conformation email will be sent to all contacts provided on this form once your application is undergoing review.

Nun Study Materials Request Form

Requesting Investigator Information

Contact Investigator Information

Alternative Contact

Sample Requests

Sample Set Information

Brain Sample Request

Biospecimen sample information (select all that apply): Unstained Slides

Nun Study

HAAS

Digital Images

Nun Study

HAAS

Biofluid Sample Request

Biospecimen sample information (select all that apply):
Unstained Slides