Make a request

Please complete the following online form so that your request can be evaluated by the coordination team.

If you do not wish to complete the online form, you can download the request form below and send it to the following address: canivet.c@chu-toulouse.fr.

Formulaire de demande échantillons [79.4 Ko]

Requested database

BACAP

PACTOL

Person in charge of the project

Full name of the project leader

Project manager's email

Affiliated organization

Names of collaborators

Contact for sample shipment

Scientific project

Project title

Justification for the research Indicate the relevance of clinical data in your project, present preliminary results (provide publications if applicable)

Primary objective

Secondary objectives

Primary endpoint

Secondary endpoints

Inclusion criteria

Exclusion criteria

Analysis method* *

Justification for the number of samples *Indicate the sample size calculation and justify the number of samples per subject

Requested clinical data *Indicate the clinical data required for the project

Project budget Participation in the fixed travel allowance, data extraction costs, and costs for sample preparation and release

Project start date * These criteria must be validated by a referring clinician and/or methodologist.

Type of Sample

Whole blood Indicate the required volume per patient

Plasma Indicate the required volume per patient

Serum Indicate the required volume per patient

Saliva Indicate the required volume per patient

DNA Indicate the required volume per patient

RNA Indicate the required volume per patient

Surgical specimen

Slides Per patient

Frozen tumor shavings

Paraffin-embedded adjacent tissue slides

Frozen adjacent tissue shavings

EU-FNA sample

Unstained paraffin slides

Person responsible for the project

Preferred shipping conditions

Preferred shipping date

I commit to :

complying with current legislation regarding the use of human biological samples in scientific research,
using the transferred biological material exclusively within the scope of the research described in the request,
not reusing the transferred biological material for research purposes other than those described in the request without the prior written consent of the BACAP Scientific Committee,
not transferring the samples obtained from the database to any third party for purposes other than the continuation of the research outlined in my request,
not using the transferred biological material for therapeutic purposes or for experimentation on humans,
not using the obtained tissues or their derivatives for profit,
informing the BACAP Scientific Committee of the termination of the research project,
acknowledging the contribution of BACAP and INCa in any publication resulting from the study, and in the event of any invention or patent application,
informing the BACAP project coordinator of the final status of the samples.