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CU-CAVP: Study Profile

Returning?

A A A

We are happy to help support your research!

In order to set your study up in our system we'll need the following information. Until we have this information and have the appropriate contracts in place we will not be able to receive samples.

Study teams will need to complete a survey for each project.

Please keep correpsondence for each project separate.

Feel free to contact us with any questions/concerns.

Please include PI, short study title, and RedCap Profile ID in the subject of all emails and include both Lucas Ellison and Kayla Campbell.

Lucas Ellison

Assistant Lab Manager

lucas.ellison@cuanschutz.edu

Kayla Campbell

Contract Coordinator

kayla.campbell@cuanschutz.edu

Study Title

* must provide value

Short Study Title

* must provide value

PI Email

* must provide value

PI Phone Number

* must provide value

Name of person completing this form

* must provide value

CAVP PI you're working with (receiving scientist)

* must provide value

Dr. Peter Anderson

Dr. Jennifer Kiser

Dr. Kristina Brooks

Dr. Jose Castillo-Mancilla

reset

Type of agreement requested

* must provide value

Fee-for-service/Master Lab Services Agreement

Grant/Sub-Award

reset

MTA required

* must provide value

Yes

Not sure

reset

Sample Type	Number of Samples






Sample Type:
Sample Type:
Sample Type:

Are samples being shipped from outside the United States?

* must provide value

Yes

reset

Are samples known to be infectious?

* must provide value

Yes

reset

Which medication type will your subjects be taking?

* must provide value

Truvada based regimen

Descovy based regimen

Other regimen

Will this study support an IND/NDA application?

* must provide value

Yes

reset

Do you plan to post on Clinicaltrials.gov?

* must provide value

Yes

reset

Grant Number

NCT Number:

IRB Status	Name of IRB	IRB Number

Please upload the current STUDY protocol.

* must provide value

Upload file

Please upload the current LAB protocol.

* must provide value

Upload file

What is the exact address samples will be shipped from?

* must provide value

Expand

Expected Arrival date of FIRST shipment (mm/yyyy)

* must provide value

Expected arrival date of FINAL shipment (mm/yyyy)

* must provide value

We assay samples in batch. If you require a timeline different than our usual batching contact both

Lane Bushman (lane.bushman@cuanschutz.edu)

Lucas Ellison (lucas.ellison@cuanschutz.edu)

to make sure we can accomodate your timeline.

When samples are ready to be shipped please coordinate with

Lane Bushman (lane.bushman@cuanschutz.edu)

Lucas Ellison (lucas.ellison@cuanschutz.edu)

NOTIFICATION OF SHIPMENTS MUST BE SENT PRIOR TO SHIPPING

PLEASE WAIT FOR CONFIRMATION TO ENSURE THE LAB IS STAFFED TO RECEIVE

Notification should include an electronic manifest

Please provide at least one contact for each role. Can select multiple roles for each row.

Role(s)	Name	Email	Phone Number

These fields will populate once the responses have been submitted. Please download your Response PDF when prompted after submission and save with your study records. You can also opt to have the responses emailed to you.

Your Redcap Profile ID is ______

Your return code is ______

Return URL: https://redcap.ucdenver.edu/surveys/?s=7PCD9M8EKK

Include PI name, Study Short Title, and RedCap Profile # in the subject of ALL emails.

Fields below have been retired 4/20/22

Fields below cannot be seen on the survey but should still be available to CAVP staff accessing information. When/if information is moved to new fields, retired fields can be hidden completely or deleted.

Sample type

* must provide value

DBS

Plasma

PBMC

Urine

Serum

Tissue

Other

Total number of samples expected for CAVP processing?

* must provide value

Comments:

Expand

We assay samples in batch--- Do you need any other assaying timelines?

* must provide value

Yes

reset

Shipping Contact Name

* must provide value

Shipping Contact Email

* must provide value

Shipping Contact Phone Number

* must provide value

Additional Shipping Contact Name

Additional Shipping Contact Email

Additional Shipping Contact Phone Number

Results Contact Name

* must provide value

Results Contact Email

* must provide value

Results Contact Phone Number

* must provide value

Additional Results Contact Name

Additional Results Contact Email

Additional Results Contact Phone Number

Invoicing Contact:

* must provide value

Invoicing Contact Email:

* must provide value

Invoicing Contact Phone Number

* must provide value

Additional Invoicing Contact:

Additional Invoicing Contact Email:

Additional Invoicing Contact Phone Number

Mark field as:

[Clear value]

Not applicable (NA)

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.