ࡱ > bjbjcTcT . > > % % % % 8 ] < % $ E Q " s s s N F D 7$ 9$ 9$ 9$ 9$ 9$ 9$ $ % R( ]$ N N ]$ s s r$ ` ` ` p s s 7$ ` 7$ ` ` " '# s ?
m % ~ d " #$ $ 0 $ " , ( " ( '# ( '# ` ]$ ]$ \ $ ( : DTR PROPOSAL FORM
Collaborators outline proposal of a project to use existing DTR data and/or biological samples or for the collection of new data
1.Applicants:
Principal applicant:Name: Institution:Email:Telephone:DepartmentAddress:Co-applicants:Names:2.Project title
Proposed Start date:Proposed End date:3.Funding:Has the project been or will it be peer reviewed? Yes FORMCHECKBOX No FORMCHECKBOX If so, by what organisation? Source of funding: (If not specified above) Has funding been sought? * Yes FORMCHECKBOX No FORMCHECKBOX What is the deadline for application to the funder?*Please note that applications for funding must be reviewed by the DTR PRIOR to submission to a funding body, require a DTR member to be a Co-Applicant and should be received AT LEAST three weeks before the deadline for submission.4.Variables requested:Please indicate which of the following are requested/required for this proposal & give full details in your scientific outline (pg 4):Existing questionnaire data FORMCHECKBOX Indicate the subset you requireExisting data from twin visits FORMCHECKBOX Indicate the subset you requireExisting data from biological samples FORMCHECKBOX Existing samples (eg. serum, plasma) FORMCHECKBOX New questionnaire data FORMCHECKBOX New data from twin visits FORMCHECKBOX New data from biological samples FORMCHECKBOX New samples (eg. serum, plasma) FORMCHECKBOX Genomewide scan data FORMCHECKBOX GWAS Results FORMCHECKBOX
5.Justification:
Please state below the rationale for using DTR data for this study, including consideration of other study methods considered (e.g. case-control):
6.Ethical approval:Does the study have ethical approval from a recognised Institutional Review Board/Ethics Committee? Yes FORMCHECKBOX No FORMCHECKBOX NA FORMCHECKBOX For analysis of existing data, generic DTR Ethics approval will operate and the NA box above may be ticked.If Yes, please append a copy of the approval.If No, please specify arrangements for obtaining appropriate approvals:7.Laboratory Analysis:If the study involves analysis of biological samples (including DNA) please give details of the laboratory where analysis will be carried out. Also please provide list of all proposed genotypes and sample analysis in appendix.Laboratory:
Contact person in your laboratory:Is your laboratory covered by a Human Tissue Authority licence? Yes FORMCHECKBOX No FORMCHECKBOX
If Yes, please give contact details of HTA designated individual.
8.Scientific outline:
Please provide a 1-2 page outline of your proposal (see pg 4), highlighting the specific requirements of the project for the DTR data specified above. Please ensure that for studies involving biological samples (including DNA) that you specify the material requested and the volume and concentration required.
As these details will become part of the data transfer agreement, please be as specific as possible about any phenotype data required. It would be helpful at this stage if you could list DTR variable codes of interest - either P (phenotype) or Q (questionnaire) codes (please see website HYPERLINK "http://www.twinsuk.ac.uk" www.twinsuk.ac.uk phenotype list under Scientific Community) - or give summary variables (eg. Migraine) and also indicate the sample size, types of twin, and age range.
Example of information we need to be included:VariableP or Q codes Twin typeSample size, & Age rangeMigraineSummary variableMZ & DZFemales onlyAll aged 30-60IGE in SerumP002584MZ only Males & Females1,000 aged 18-809.Agreement:Signature:If you are sending this form by email then you should note that in the absence of an electronic signature, the emailing of this proposal constitutes your personal certification that the details are correct.Date:
Name (on behalf of Applicants)
.
Please fill in the project scientific outline (pgs 4-6) and then send completed form to HYPERLINK "mailto:victoria.vazquez@kcl.ac.uk" victoria.vazquez@kcl.ac.uk
This form has been designed to comply with the Wellcome Trust requirements and Open Access guidelines
Project scientific outline
Please ensure you address the following questions in you proposal:
What material/data do you require?
Describe sample size, types of twins and age range requested.
Describe the research will you be undertaking with the material/data.
Are the materials/data currently available (existing) or will they need to be collected (new)?
Is genotype data required?
Will new data be collected by questionnaire or during twin visits?
Will you require any help from DTR statisticians for analysis of data? If so, please give details of extent of help required.
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