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Puerto Rico Clinical and Translational Research Consortium
Genomic Translational Research Unit
**Temporarily, this service will be offered according to the availability of our personnel**
To request our services please complete the following information regarding your request for
services/support to PRCTRC Genomic Translational Research Unit with the required
documents and send it to: prctrc.rcm@upr.edu. If you have any question, please contact:
 Jessicca Renta-Torres, MS- jessicca.renta@upr.edu or 787-758-2525 ext. 1637
 Carmen L. Cadilla-Vázquez, PhD- carmen.cadilla@upr.edu or 787-758-2525 ext.1372
 Lilliam R. Villanueva-Alicea, MS- lilliam.villanueva@upr.edu or 787-758-2525 ext. 1633
I. Principal Investigator Information
1. Name (Last Name, First
Name):
2. Degree:
3. Current Position:
4. Years in current
position:
5. Institution:
6. School:
7. Department:
8. Program:
9. Section (if applicable):
10. Email:
11. Phone (XXX-XXX-XXXX):
Degree
Select
Select your Academic Affiliation
Select
Select
II. Request for Services
Please specify which service(s) you want to receive: (**Please discuss this with the lab contact
personnel [carmen.cadilla@upr.edu or jessicca.renta@upr.edu] before your selection(s))
DNA extraction and QC
RNA extraction, cDNA template preparation, and QC
Library Preparation for Sequencing, Templates preparation
DNA Sequencing Reactions (type of service: whole genome, whole exome, transcriptome (RNAseq), ChIPSeq, other)
Processing of raw data for subsequent bioinformatics analyses by investigator
Other, please specify:
Rev. 05.20.15
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III. Samples Description
Please provide information related to the samples that will be used through the Translational
Genomic Research Unit.
12. Type of sample:
13. Type of organism:
14. Number of samples:
15. Number of runs per samples:
PRCTRC Genomic Research Unit
IV. Study Description
Please indicate information regarding the study/protocol from the samples was collected:
16. Project Title:
17. Research Areas:
Cardiovascular
Cancer
Other:
HIV
Neuroscience
18. IRB/IACUC Number:
19. IRB/IACUC Expiration Date:
(mm/dd/yyyy)
20. Please provide a brief description of the study (< 250 words): **Include all that apply: (a)
objective/specific aims of the study, (b) research plan, (c) methodology, and (d) findings,
results or conclusions reached to date.**
V. Study Funding Support
Please provide information regarding the study/protocol funding support.
Federal
Sponsor
Institution/Agency
Name
NIH
**Specify grant Principal Investigator (PI)
Other
Non- Federal
Industry
Foundation/ Research
Institute Funds
Professional and Voluntary
Association or Society Funds
State, Country, City funds
None
Other
Investigator Initiated
Rev. 05.20.15
Grant #
Please access the following link to verify the
grant number and PI information
http://projectreporter.nih.gov/reporter.cfm
Total Budget
(For funding period)
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VI. Required Documents
For the PRCTRC to support your research project, we will need the following documents to
report on our outcomes and justify our budget to NIH. Thanks in advance!
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PI Biosketch (see Requesting Services from the PRCTRC-Biosketch form and example)
Copy the IRB/IACUC Approval Letter
Copy Biosafety Committee Approval
PI Training Certifications (Human Subject Protection, HIPAA, IACUC,
Biosafety/Biosecurity Training- if applicable)
VII. Investigator Responsibilities
1
Progress report: We will request an annual progress report for each
study. This information is part of NIH requirements to continue funding
PRCTRC.
2
Data sharing: Data sharing is essential for expedited translation of
research results into knowledge, product and procedures to improve
human health. The National Institutes of Health (NIH) has a policy to
share and make available to the public the results and accomplishments
of the activities that it funds.
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Acknowledgement of support: Each publication, press release or other
document that results from NIH grant supported research must include
an acknowledgment of NIH grant support and disclaimer such as:
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The PRCTRC is committed in providing each study the best possible
service. Due to a reduction in federal funding we may bill services for
cost recovery. These funds will be used to continue supporting research
projects.
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The project described was supported by Award Number 2U54MD007587 from the
National Institute on Minority Health and Health Disparities. The content is solely the
responsibility of the authors and does not necessarily represent the official views of the
National Institute on Minority Health and Health Disparities or the National Institutes
of Health.
I,
, agree to fulfill the Investigator’s responsibilities and submit the information
requested by Puerto Rico Clinical and Translational Research Consortium (PRCTRC).
Rev. 05.20.15