Letter of Intent for Mesothelioma Tissue Samples Primary Investigator (required) Email (required) Position Instituion Street City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Phone Co-Investigators Title of the Study Submission Date Lay Abstract Specific Aim(s) Background and Hypothesis Technical Approach and Methods Approximate number and types of cases required Justification for sample size and proposed statistical analysis Assurance that the technique(s) can be applied to parrafin-embedded, DNA, or blood samples Clinical (Demographic and Epidemiologic) and/or Outcome and Follow-up data required IRB Status IRB Type Approval