Request Form

Requestor

If you have an existing NGVB account please:

Choose a request type*

Are you the PI?
PI:* Email:* Organization:*
Areas of Research:

Heart

Lung

Blood (not cancer)

Cancer

Diabetes

Neurologic

Kidney

Musculoskeletal

Vision

Infectious disease

Psychiatric

Other

Funding Source

Grant/Contract Number

Assurances From You

I attest that our institution is non-for-profit institution or government agency eligible to receive NIH funding.
I attest that the materials will be used in compliance with current regulatory guidelines and approved by the appropriate oversight boards (ex. Animal Care and Use Committees, Institutional Biosafety Board, FDA, or other applicable agencies).
I agree to assurances and certification requirements as described in the Application for Public Health Service Grant (PHS 398 Section III.G http://grants.nih.gov/grants/funding/phs398/phs398.pdf).
I agree to acknowledge the NGVB in all relevant publications.
I agree to abide by the policies as outlined the NGVB Policy and Procedure Manual (NGVB Policy and Procedure Manual).
I understand shipping charges are the responsibility of the investigator.

Assurances From The NGVB

Material will be used only for regulatory testing.
Material not used in testing will be retained unless otherwise specified by the submitting investigator.
Materials will remain the property of the submitting investigator and will only be released after written request of the investigator or their designee.
Archived samples will be maintained in a temperature monitored environment. Out of specification reports will be provided for any variance in environmental conditions.

I agree to NGVB Terms and Conditions*

(To change any of the information below, please click on the corresponding section tab on the left)

Requestor

Request Details

Investigator