Please specify: Consent Attached? (Include Yes consent to be used with No application, if applicable). Does the study involve genetic Yes research? No If yes, please provide details: SECTION 3 Research Proposal for the of Human Tissue Primary objective and hypothesis of the Indicate the approximate number of tissue samples that will be required for this How will the tissue be identified? Will any identifying Yes information be recorded? No If yes, please specify the identifying information and justify the necessity for its collection: Will the individual Yes identifiers be removed No once the relevant data is collected? If no, please justify: How will security and confidentiality of the data be ensured? Is there any anticipated linkage of the data to be collected with a clinical database? Will the data be available Yes or distributed to others? No If yes, specify how confidentiality will be protected: the data collected Yes be used now or in the No future for commercial N/A purposes? If yes, please provide details:
Please specify: Consent Attached? (Include consent to be used with application, if applicable). Yes No Does the study involve genetic research? Yes No If yes, please provide details: SECTION 3 Research Proposal for the of Human Tissue Primary objective and hypothesis of the Indicate the approximate number of tissue samples that will be required for this How will the tissue be identified? Will any identifying information be recorded? Yes No If yes, please specify the identifying information and justify the necessity for its collection: Will the individual identifiers be removed once the relevant data is collected? Yes No If no, please justify: How will security and confidentiality of the data be ensured? Is there any anticipated linkage of the data to be collected with a clinical database? Will the data be available or distributed to others? Yes No If yes, specify how confidentiality will be protected: the data collected be used now or in the future for commercial purposes? Yes No N/A If yes, please provide details: