Center for Patient Derived Models Request Questionnaire

The code block below illustrates how one might use # and // as comments in your logic and calculations.

# Text can be put here to explain what the logic/calculation does and why.
if ([field1] = '1' and [field2] > 7,

	// This comment can explain what the next line does.
	[score] * [factor],

	// Return '0' if the condition is False.
	0
)

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This value you provided is not a number. Please try again.

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The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

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This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit North American phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

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Required format:

Thank you for your interest in selecting a model from the Center for Patient Derived Models. Please complete this questionnaire in order to submit a model request. In order to learn more about our model inventory, please visit our website or go to cBioPortal. Please feel free to contact us at models@dfci.harvard.edu with any questions.

Date of Request

* must provide value

Y-M-D

Are you a Dana-Farber Cancer Institute lab or facility?

* must provide value

Yes

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Institution

* must provide value

Requestor Name

* must provide value

Requestor Email Address

* must provide value

Requestor Phone Number

* must provide value

Requestor Job Title

* must provide value

Institution Type and Funding Source

* must provide value

Academic / non-profit institution, no industry sponsorship

Academic / non-profit institution, industry-sponsored study

Industry / for-profit

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Principal Investigator

* must provide value

Same as requestor

Different from requestor

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Principal Investigator Name

* must provide value

Principal Investigator Email Address

* must provide value

Principal Investigator Phone Number

* must provide value

Request Details and Study Description

* must provide value

Expand

Will the models be used at a Core Facility, i.e will the models be used in fee-for-service work at your facility?

* must provide value

Yes

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Please provide the name of a Technology Transfer / Business Development Office representative at your institution.

* must provide value

Please provide the email address of the Technology Transfer / Business Development Office representative at your institution.

* must provide value

Please provide the phone number of the Technology Transfer / Business Development Office representative of your institution.

* must provide value

Model Selection

Please select the model(s) that you are interested in obtaining material for. The maximum number of models that can be requested in one submission form is 10. The availability of our models can be found on cBioPortal with the VIALS_AVAILABILITY variable. If you have any questions or do not see a model you are interested in listed on this survey, please contact us at models@dfci.harvard.edu.

Please note: All liquid tumor models are available as PDX only, Brain tumor models are available as PDX or PDCL and other solid tumors are available primarily as PDX as well.

* must provide value

Model Request 1

* must provide value

Please select the material type you are interested in for Model 01.

* must provide value

Patient Derived Xenograft (PDX)