Tissue Request Proposal Form

Samples of tissues and biomolecules which have been collected by the Komen Tissue Bank may be requested by completing a Tissue Request Proposal Form. Do not complete the form on the website. Please first save the blank form to your computer, THEN complete the form by providing the required information, and save the form as a PDF file.  The file should then be emailed as an attachment to Jill Henry. In addition, please print a paper copy of the request form, have it signed by the Principal Investigator, and either email a scanned copy or return it by regular mail to:

Komen Tissue Bank, Attn: Ms. Jill Henry
550 University Blvd., AOC 6042
Indianapolis, Indiana 46202

Proposals are accepted four times during the calendar year, with the following deadlines: February 1, May 15, August 15, and November 15. All proposals must have funding and IRB approval. Each will be reviewed by a panel consisting of one internal (Indiana University – Purdue University) scientist, one external (non-IUPU) scientist, and one patient advocate. After the proposal is approved, the researcher must sign a Material Transfer Agreement requiring that all data is to be returned to the Komen Tissue Bank within a reasonable amount of time from when data has been published and intellectual property secured. Data must be returned to the Bank even if the study results are negative, i.e., the hypothesis being tested is shown not to be correct.

The KTB will endeavor to make this process as efficient and transparent as possible. Approval will be based upon the scientific merit of the proposal, the availability of sufficient samples for the proposed project, and the non-duplication of a project already in progress.

The KTB charges minimal cost recovery fees for samples. To find a schedule of these fees, please see our Cost Recovery Schedule.

KTB samples are restricted for use for breast cancer research only.


I have two reasons for donating today. First is that I am so grateful, as I’ve watched two friends battle breast cancer, I am so far eligible to donate normal tissue. Second is that I have frequently used tissue from volunteers in my own research and understand the importance of such donations. This is thanks to all who have donated for my own research.

Margaret Bauer 1/10/09