Biobank

BioSample request form

Version 5.2026. Every section of the form is below. Download the editable Word file to fill it in, and send the completed form back to the biobank.

Completed forms go to Allison Ward, PennCNDRbiobank[at]pennmedicine.upenn.edu, 215-746-8193. Requests are filled in the order in which they are approved.

Download the Word form →View it on Drive

A · Investigator information

Principal investigator, and contact if different
  • Name
  • Title
  • Email
  • Phone
  • Fax
Co-investigators
  • Names and institutions, if different
Institution
  • Institution name
  • Department name
  • Address
  • City, state or province
  • Country, zip code

B · Research project

The project
  • Project title
  • Grant title, if different
  • Principal investigator on the grant, if different
  • Grant number and dates
  • Funding source
  • Total grant amount, direct plus indirect, for the entire grant period
Approval
  • IRB approval number and expiration date — attach a copy of the IRB committee approval letter. Not strictly required for autopsy-only studies.

C · Sample request

1. Diagnostic criteria for case selection
  • Clinical diagnosis
  • Pathologic diagnosis
  • Sex
  • Sample type or region
  • Post mortem interval
  • Age of onset or death
  • Other criteria
2. Sample type and total number requested
  • Frozen tissue
  • DNA
  • RNA
  • CSF
  • Plasma
  • Tissue slides
  • Other
3. Detailed description
  • For each sample type, the relevant characteristics — amount, size, concentration, fixative, region, source, mutation status — in the context of the diagnostic criteria above. Rare or highly specific types of cases may not be available.
4. Database information requested for each sample, if available
  • Demographics — sex, race and ethnicity, other
  • Clinical — age at onset, clinical diagnosis, clinical scale, other
  • Neuropathology — age at death, PMI, neuropath diagnosis, IHC results, other
  • Genetics — genetic status for named genes, family history, other

D · Project summary

A brief abstract of under 200 words giving the aims, hypothesis and research plan, including the study cohort description and power calculations. Include a justification for the amount, regions and sample type requested, and how the samples will be used. Relevant references do not count towards the word limit.

E · Publication

Relevant Penn investigators and grants must be acknowledged.

  1. Data acquisition and data assessments — neuropathologic diagnoses, clinical diagnoses, genetic data annotation — are considered significant intellectual contributions that warrant co-authorship for relevant Penn investigators on publications using these data. Penn investigators may choose to recuse themselves from authorship depending on the content of the study.
  2. Depending on the requested samples, one or more Penn grants must be acknowledged in any publication related to their use.
  3. You will be required to provide annual updates on publications, funded grants and other research accomplishments attained using these samples.
  4. You will provide the CNDR, ADRC, PDMDC or FTDC with a PDF of any publication using these samples, for reporting to the NIH.

F · Return of raw data

Investigators requesting samples for CSF, plasma, DNA or RNA studies agree to provide all raw genotyping or expression data to CNDR for inclusion in the CNDR Integrated Database, for future use by Penn investigators, following publication of those data by the requesting investigator.

In return, once you give us your data on our samples we release the subject data you need and embargo it until you write up your paper, or for six months.

G · Financial arrangements

You provide a preferred shipping carrier and account number.

Small numbers of residual paraffin sections on glass slides may be available without charge, but this is uncommon. Following approval of a request for paraffin sections, investigators may incur some cost recovery or processing via the Pathology Core at Children's Hospital of Philadelphia to prepare the desired number of sections on a fee-for-service basis. Penn CNDR staff then provide tissue blocks to the CHOP Pathology Core. CHOP and its Pathology Core are financially and administratively independent of the Penn CNDR.

H · Legal arrangements

A Material Transfer Agreement is required for samples sent outside Penn. Typically, upon approval of this request, we initiate the MTA process at Penn. Further information is at Penn Research Services, or email ORSMTA[at]pobox.upenn.edu.

I · Disclaimers

The requesting investigator confirms they have read the human biosample handling precautions summary and accept full responsibility for ensuring that proper safe handling techniques are employed. The University of Pennsylvania ADRC, CNDR, PDMDC and FTDC cannot guarantee that donors were not exposed to or infected with contagious organisms.

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