Research Project Application

Please fill out thoroughly for your research project to be considered.

Complete all fields; if they do not apply mark with N/A. You will be contacted within five business days of receipt with a preliminary response with guidance on the next steps in the review and acceptance process.

Principal Investigator (PI) Information
Name*
First Name* Last Name*
Area of Expertise/Research Interest*
Position/Title*
Name of Research Entity*
Address*
Street Address * Address Line 2 City * State / Region * ZIP / Postal Code * Country *
Phone*
Fax:*
Email*
Website

Please note, the entire website address is required, including the pre-fix of http:// or https://.
Biospecimen Delivery Receiver and Location
Name
First Name Last Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Project Information
Project Title
Description/Public Health Relevance Statement
Do you currently have funding for this project?
- Yes
- No
Will you require a letter of support for your funding?
- Yes
- No
What is your primary source of funding for this work?
Name any additional sources of funding for this work
Is there an IRB approval process requirement?
- Yes
- No
Existing IRB Number

If not applicable, please mark NA.
Will you require a non-disclosure agreement related to research specifics?
- Yes
- No
Estimated Duration of Study
Please tell us briefly what resources your project requires, including data, non-transplantable organs and/or tissue or other resource. Please be specific in your description.
Acknowledgement*
I agree.
In submitting this application, the submitter hereby agrees to acknowledge the support of LifeLink Foundation and generosity of organ and tissue donors and their families in making possible the study or project’s success and shall agree to state such an acknowledgment in any publication, presentation, abstract, grant application or poster resulting from this support.

Principal Investigator (PI) Information

Biospecimen Delivery Receiver and Location

Project Information