Request for Tissue from the CRC Tissue Bank
Note: In order to access more than 10 samples, it is requested that the investigator
demonstrate proof of principle for the studies proposed. If you are doing IHC, please
provide evidence of staining with positive and negative controls. If you are doing
molecular studies, please provide preliminary data demonstrating feasibility of the use of
tissues for such studies. For validation studies, statistical considerations are required.
Investigator: ______________________________________________
Department:
______________________________________________
Collaborators: ______________________________________________
______________________________________________
Title of Project: ____________________________________________
Company Center number for Charges:___________________________
Is this a preliminary study (max tissues allocated n=10) or a larger validation study?
(circle or underline one)
Brief Description (<200 words)
Tissue Request:
Paraffin-embedded slides _____ (number of slides___)
OCT sectioned slides _____ (number of slides___)
Tumor snap frozen _____ (amount___mg)
Normal tissue snap frozen _____ (amount___mg)
Special requests:
Statistical considerations for the number of samples requested
IRB approval: Protocol number _____ Date of approval_____
Please submit requests via email to Dr. Dipen Maru
(Tissue allocation committee: Dipen Maru (Chair), Stanley Hamilton, Asif Rashid, Lee Ellis,
Cathy Eng, Scott Kopetz, Miguel Rodriguez-Bigas)