CCOGC Tissue Release Application
Due: August 1, 2017
I: Principal Investigator Information
NameDegree
Title
Institution Type
Academic Government Industry Other
Shipping Address:
Telephone Number
FedEx shipping account number
II: Project Information
Project Title
Application Tier:
Tier 1: Requests supported by grants/awards from the American Kennel Club-Canine Health Foundation (AKC-CHF) or Morris Animal Foundation (MAF)
Tier 2: Requests supported by grants/awards from the National Institutes of Health (NIH)
Tier 3: Requests supported by grants/awards from other agencies (including intramural university sources)
Tier 4: All other applications
III: Project Information
Project Description (300 words or less)
IV: Sample Selection
Each of the 7 tumor typesare listed below. Please check the specimen type you are interested in and the number of aliquots requested.
Yes, I would still like to be contacted if the CCOGC is only able to partially fulfill my order
Osteosarcoma
Estimation of osteosarcoma patient numbers
Specimen type(s): estimate aliquots per patient
Tumor
Flash Frozen Tumor: Number of aliquots
Formalin Fixed Tumor: Number of aliquots
OCT Frozen: Number of aliquots
Normal Tissue (typically skin or muscle)
Flash Frozen Tumor: Number of aliquots
Formalin Fixed Tumor: Number of aliquots
OCT Frozen: Number of aliquots
Other
Whole Blood EDTA: Number of aliquots
PAXgene RNA: Number of aliquots
Serum: Number of aliquots
Plasma: Number of aliquots
Melanoma
Estimation of melanoma patient numbers
Specimen type(s): estimate aliquots per patient
Tumor
Flash Frozen Tumor: Number of aliquots
Formalin Fixed Tumor: Number of aliquots
OCT Frozen: Number of aliquots
Normal Tissue (typically skin or muscle)
Flash Frozen Tumor: Number of aliquots
Formalin Fixed Tumor: Number of aliquots
OCT Frozen: Number of aliquots
Other
Whole Blood EDTA: Number of aliquots
PAXgene RNA: Number of aliquots
Serum: Number of aliquots
Plasma: Number of aliquots
Lymphoma
Estimation of lymphoma patient numbers
Specimen type(s): estimate aliquots per patient
Tumor
Flash Frozen Tumor: Number of aliquots
Formalin Fixed Tumor: Number of aliquots
OCT Frozen: Number of aliquots
Normal Tissue (typically skin or muscle)
Flash Frozen Tumor: Number of aliquots
Formalin Fixed Tumor: Number of aliquots
OCT Frozen: Number of aliquots
Other
Whole Blood EDTA: Number of aliquots
PAXgene RNA: Number of aliquots
Serum: Number of aliquots
Plasma: Number of aliquots
Pulmonary Tumors
Estimation of pulmonary tumor patient numbers
Specimen type(s): estimate aliquots per patient
Tumor
Flash Frozen Tumor: Number of aliquots
Formalin Fixed Tumor: Number of aliquots
OCT Frozen: Number of aliquots
Normal Tissue (typically skin or muscle)
Flash Frozen Tumor: Number of aliquots
Formalin Fixed Tumor: Number of aliquots
OCT Frozen: Number of aliquots
Other
Whole Blood EDTA: Number of aliquots
PAXgene RNA: Number of aliquots
Serum: Number of aliquots
Plasma: Number of aliquots
Hemangiosarcoma
Estimation of hemangiosarcoma patient numbers
Specimen type(s): estimate aliquots per patient
Tumor
Flash Frozen Tumor: Number of aliquots
Formalin Fixed Tumor: Number of aliquots
OCT Frozen: Number of aliquots
Normal Tissue (typically skin or muscle)
Flash Frozen Tumor: Number of aliquots
Formalin Fixed Tumor: Number of aliquots
OCT Frozen: Number of aliquots
Other
Whole Blood EDTA: Number of aliquots
PAXgene RNA: Number of aliquots
Serum: Number of aliquots
Plasma: Number of aliquots
Mast Cell Tumor
Estimation of mast cell tumor patient numbers
Specimen type(s): estimate aliquots per patient
Tumor
Flash Frozen Tumor: Number of aliquots
Formalin Fixed Tumor: Number of aliquots
OCT Frozen: Number of aliquots
Normal Tissue (typically skin or muscle)
Flash Frozen Tumor: Number of aliquots
Formalin Fixed Tumor: Number of aliquots
OCT Frozen: Number of aliquots
Other
Whole Blood EDTA: Number of aliquots
PAXgene RNA: Number of aliquots
Serum: Number of aliquots
Plasma: Number of aliquots
Soft Tissue Sarcoma
Estimation of soft tissue sarcoma patient numbers
Specimen type(s): estimate aliquots per patient
Tumor
Flash Frozen Tumor: Number of aliquots
Formalin Fixed Tumor: Number of aliquots
OCT Frozen: Number of aliquots
Normal Tissue (typically skin or muscle)
Flash Frozen Tumor: Number of aliquots
Formalin Fixed Tumor: Number of aliquots
OCT Frozen: Number of aliquots
Other
Whole Blood EDTA: Number of aliquots
PAXgene RNA: Number of aliquots
Serum: Number of aliquots
Plasma: Number of aliquots