APPENDIX 9
OKLAHOMA CHRISTIAN UNIVERSITY
BIOLOGICAL MATERIALS FORM
Instructions: Researchers planning to collect, analyze, or bank human cells, tissues, fluids, DNA or other human biological
samples (existing or to be collected) as part of the research must complete this form and include it with the IRB
Application.
Responsible Project Investigator (RPI)
1) RPI First Name
RPI Last Name
2) Project Title
3) Describe the materials that will be collected, analyzed, or banked by the investigator(s).
4) What type of samples will be used? (Check one)
‘
Samples are unidentified (anonymous)-identifying information was not or will not be collected, or if collected
by a repository was not maintained and cannot be retrieved by repository
‘
Samples are identified-links to personal information exist somewhere or will be collected and
maintained (Go to 4b)
4b) If samples are identified
‘
Samples are unlinked (“anonymized”)-samples are provided to investigator without identifiers or codes
that can link to identifiers
‘
Samples are coded (“linked” or “identifiable”)-provided to investigator with codes that are linked to identifiers
‘ Samples are identified-provided to investigator with identifying personal information
5) What is the intended use of the samples for purposes of the current protocol?
5a) Where will the samples be stored?
5b)
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In what manner will samples be stored?
Frozen
Cell lines
Paraffin Blocks
Other_
5c)
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Who will have access to samples? (Check all that apply)
Samples will be used by members of the research team
Samples will be shared with outside researchers
Other_
6) Will the samples be destroyed after this purpose is served?
‘ Yes
‘ No (go to 6a)
6a) Will you utilize samples in the same manner?
‘ Yes
‘ No (If no, please describe)