ADCS Biospecimen Repository

The ADCS laboratory at UCSD banks human tissues from ADCS clinical trials. To place a specific request, please fill out all the forms below detailing the investigator/institution name, the clinical trial you are interested in and the type of sample needed for the analysis. If you have questions regarding this form or the samples available, please contact Dr. Robert Rissman, Director of ADCS Laboratory and Biospecimen Bank (rrissman@ucsd.edu)

Name of Investigator*	*
Investigator's Institution and Department*	* 100 characters max
Email Address*	* *
Mailing/Shipping address*	* 100 characters max
City*	*
State/Province *	*
Country*	*
Zip*	* 15 characters max
Telephone number*	* 20 characters max
Fax
Summary of proposed study using ADCS samples	7000 characters max

Material Transfer Agreement ADCS investigators requesting human tissue, blood or plasma are not required to complete a material transfer agreement (MTA) if they are requesting samples that were collected during clinical trials they directly participated in for research related to the trial. Requests for DNA, urine or CSF require MTAs regardless of participation. Non-ADCS Investigators are required to complete an MTA for all tissue requests. Please select this box if an MTA will be required for this request.

Start with:
Clinical Trial:	*	Type of Sample:	*
Time Point:		Test Results:

Specific Inclusion Criteria (patient demographic requirements)	1000 characters max
Please use "Add" button to add the item you would like to request from us. After you finish adding all items from our inventory, please click "Done".

Material Transfer Agreement

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