Donor Network West

  • Research Project Application

    Donor Network West

  • Thank you for your interest in obtaining biospecimen samples for research through Donor Network West. To proceed, please complete this project application. Please provide as much detail as possible regarding your research protocol to facilitate our review. Upon receipt of your completed application, a member of our Research Team will contact you regarding next steps. If you experience any issues with your submission, please contact Dr. Ahmad Salehi (asalehi@dnwest.org).

  • Principal Investigator Information

    • Primary Contact Information 

    • Primary Contact Information

    • Project Information 
    • Is this a data request only?*
    • Do you currently have funding for this projcet?*
    • Funding 
    • Will You Require a Letter of Support for Your Funding?
    • IRB Approval
    • Biospecimen Information Primary 
    • Per biospecimen type, how frequently will you want to receive specimens?

    • Required Solution/Preservation

    • Solution
    • Preservation
    • Biospecimen Information Secondary 
    • Per biospecimen type, how frequently will you want to receive specimens?

    • Required Solution/Preservation

    • Solution
    • Preservation
    • Recovery & Allocation Information 

    • Recovery Information

      Please enter time frames you are able to recover

    • Times Available

    • Allocation Information

      Please list times available to take calls regarding accepting placement of specimen(s)
    • Criteria 
    • Sex
    • Race
    • Serology - Would you consider specimens from a donor who has tested positive for Hepatitis B, Hepatitis C, or HIV?  (no serology is performed for brain for research donors)
    • Delivery Location 

    • When are you available to receive specimens? Write in the time frames below.

    • Courier Information 
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