Puerto Rico Clinical and Translational Research Consortium

Puerto Rico Clinical and Translational Research Consortium Genomic Translational Research Unit **Temporarily, this service will be offered according to the availability of our personnel** Instruction

To request our services please complete the following information regarding your request for services/support to PRCTRC Genomic Translational Research Unit with the required documents and send it to: [email protected]. If you have any question, please contact: . Jessicca Renta-Torres, MS- [email protected] or 787-758-2525 ext. 1637 . Carmen L. Cadilla-Vázquez, PhD- [email protected] or 787-758-2525 ext.1372 . Lilliam R. Villanueva-Alicea, MS- [email protected] or 787-758-2525 ext. 1633

A. Required Documents As the PRCTRC collaborates for the success of your project, we will need the following documents; these will be sent to NIH to report on our outcomes and justify our budget. (To open the links hold down “Ctrl” button)  PI Biosketch  Copy the IRB/IACUC Approval Letter  Copy Biosafety Committee Approval Letter  PI Training Certifications (Human Subject Protection, HIPAA, IACUC, Biosafety/Biohazard Trainings- if applicable)

Incomplete applications will not initiate the evaluation process.

Rev. 09.15.15 B. Request for Services Please specify which service(s) you want to receive: (**Please discuss this with the lab contact personnel [[email protected] or [email protected]] before your selection(s)) DNA extraction and QC

RNA extraction, cDNA template preparation, and QC

Library Preparation for Sequencing, Templates preparation

DNA Sequencing Reactions (type of service: whole genome, whole exome, transcriptome (RNAseq), ChIPSeq, other)

Processing of raw data for subsequent bioinformatics analyses by investigator

Other, please specify:

C. Principal Investigator Information

1. Name (Last Name, First Name): 2. Degree: 3. Current Position: 4. Years in current position: 5. Institution: 6. School: 7. Department: 8. Program: 9. Section (if applicable): 10. Email: 11. Phone (XXX-XXX-XXXX):

D. Samples Description Please provide information related to the samples that will be used through the Translational Genomic Research Unit.

 Type of sample:  Type of organism:  Number of samples:  Number of runs per samples: E.

Rev. 09.15.15 F. Study Description Please indicate information regarding the study/protocol from the samples was collected:

P 1. Project Title: R Cardiovascular HIV C Cancer Neuroscience T 2. Research Areas: R Other: C 3. IRB/IACUC Number: 4. IRB/IACUC Expiration Date: G e (mm/dd/yyyy) n 5. Please provide a brief description of the study (< 250 words): **Include all that apply: (a) o objective/specific aims of the study, (b) research plan, (c) methodology, and (d) findings, m results or conclusions reached to date.** i c

R e s e a r c h

U n i t

G. Study Funding Support Please provide information regarding the study/protocol funding support. Institution/Agency Total Budget Sponsor Grant # F Name e (For funding period) d NIH Please access the following link to verify the e grant number and PI information r http://projectreporter.nih.gov/reporter.cfm a **Specify grant Principal Investigator (PI) l Other Industry

Rev. 09.15.15 N Foundation/ Research o n Institute Funds - Professional and Voluntary Association or F Society Funds e State, Country, City d e funds r a Other l N o Investigator Initiated n e

Rev. 09.15.15 I. Investigator Responsibilities

The project described was supported by Award Number 2U54MD007587 from the National Institute on Minority Health and Health Disparities. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Minority Health and Health Disparities or the National Institutes of Health.

I, , agree to fulfill the Investigator’s responsibilities and submit the information requested by Puerto Rico Clinical and Translational Research Consortium (PRCTRC).

Rev. 09.15.15