ACCESS REQUEST FORM

Prospective applicants must demonstrate that they are knowledgeable researchers who have access to a well-developed laboratory and have had previous experience in research or have collaborators with documented experience in research. This is a requirement to secure that the precious material will be used in the best possible and promising way without risking its improper use. Applicants cannot be students.

A) Investigator information

Name of Principal Investigator

Email of Principal Investigator

Major Collaborators

Major Partners

B) Investigator information

The Host Organization is the Organization where proposed research will be conducted.

Identity of Host Organization

Address of Host Organization

C) Funding Information

Identity of Funding source

Amount of Funding

D) Summary of proposal (2000 - 3000 characters)

Characters remaining: 3000

E) Major specific aims (2000 - 3000 characters)

Characters remaining: 3000

F) Description of Methodology with major tools to use (max 6000 characters)

Characters remaining: 6000

G) Impact expected from the proposed research (2000 - 3000 characters)

Characters remaining: 3000

H) Material and data requested (1000 - 2000 characters)

Characters remaining: 2000

Signatory who is authorized to sign the MTA/DTA

Name of Signatory

Email of Signatory

Applicant details

Name of Applicant

Application date

Email of Applicant

I hereby declare that the information provided is true and correct

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