Researchers working within the Clinical Research Facility, Royal Devon & Exeter Foundation Trust and University of Exeter may ask the Peninsula Research Bank (PRB) Steering Committee for permission to access the samples stored within the PRB. Before this is approved, evidence of scientific review and ethical approval must be supplied to the Steering committee.

In order to determine how many samples in the PRB meet your inclusion/exclusion criteria, please complete the “Extend Criteria Form” and send it to Steve Spaull (). Once you know how many samples are suitable for your study, please complete the application below and send to Louisa Allen () as early as possible. This will be reviewed by the PRB steering committee at their next meeting.

Please note: If you are storing samples, you MUST contact Gail Seymour () or Jackie Whatmore () regarding material transfer agreements.

Request to access samples from the Peninsula Research Bank Database

Name of PI:
Name of Study:
In lay terms, please describe the study, why you need the samples and why this research is important
CRF number:
R&D approval number:
Has the project been scientifically reviewed? (*delete as applicable)
If yes, please attach a copy of the review to this request .
If no, please attach a scientific protocol/justification. / * Yes / No
Please provide evidence of statistical reasoning for the number of samples requested (e.g. power calculation or similar justification):
Please attach a CV and/or evidence that you have the expertise and experience to process these samples effectively:
Please give details of the funding available to analyse these samples (i.e. how much and where from?)
How many samples have been identified in the PRB cohort that meet your inclusion criteria?
Which samples do you wish to use, and how many of each do you require?
Fresh EDTA tube (7.5ml)
Pre-extracted DNA (100ul aliquot of +/- 100ng/ul)
Plasma (0.6ml aliquot)
Serum (0.6ml aliquot)
Urine (1.2 ml aliquot)

Declaration: I understand that I may only use the samples provided for the purpose described above and once this study has been completed I must either destroy the samples using an HTA acceptable method (if volumes do not merit re-use) or return the samples to the Peninsula Research Bank (PRB). I understand that I must alert the PRB if I discover any information that may have clinical relevance to the donor of the sample. I also understand that I am expected to provide the PRB with data generated from this project. I understand that I am also required to provide updated information on samples to the PRB, to ensure that records remain accurate.

Signed: …………………………………………………………………………………………………………………….

Print Name: …………………………………………………………………………………………………………………

Date: ………………………………………………………………………………………………………………………….

PRB Request To Access Samples v2 13oct17