Unfunded Collaboration Research Agreement (CRA)

1. BU Contact Information:

BU Principal Investigator (PI) Name:*

BU PI Department:*

BU PI Phone*

BU PI Fax

BU PI Email*

BU PI Email (confirm)*

BU PI Lab Location*

(Include room, street, and ZIP code.)

(optional) Check here if to specify an alternate BU contact besides the PI.

Alternate BU Contact Name and Email:

2. External Party who will be participating in exchange of Data:

External Party Institution Name:*

External Party PI:*

External Party PI Phone*

External Party PI Email*

External Party Administrative Contact (if known):

External Party Administrative Contact Phone

External Party Administrative Contact Email

3a. Who will be sharing Data?*

Inbound - External party will share Data with BU
Outbound - BU will share Data with External party
Mutual - Both parties will share Data

Please describe the nature of the Data you are going to RECEIVE.*

Please describe the nature of the Data you are going to PROVIDE.*

Please describe the nature of the Data that the parties are going to EXCHANGE.*

3b. Who will be sharing Material?*

(Materials can be physical substances – human or otherwise)

Inbound - External party will share Material with BU
Outbound - BU will share Material with External party
Mutual - Both parties will share Material

Please describe the nature of the Material you are going to RECEIVE.*

Please describe the nature of the Material you are going to PROVIDE.*

Please describe the nature of the Material you are going to EXCHANGE.*

4a. Provide the BU location where research Collaboration will be conducted.*

(Include room, street, and ZIP code.)

4b. If BU is a PROVIDER of Data and/or Materials for this Collaboration, provide the BU location of the research that generated the Data and/or Material and the project title(s), grant/award number(s), sponsor(s) name(s) associated with that research.*

(Include room, street, and ZIP code.)

5. Provide a description of the research to be conducted in this Collaboration.*

6a. Will you be using the Material in animals?*

Yes
No

6b. Will you be receiving live animals as a part of this Collaboration?*

Yes
No

Please provide your IACUC protocol number*

7. Do you have IBC approval for the use of the Material?*

Yes
No
N/A

Please provide your IBC protocol number.*

8. Is the Material biohazardous?*

Biohazardous materials, infectious agents, select agents, human blood, tissues, cells & cell lines, etc.

Yes
No

What is the Biosafety Level (BSL) of the Material?**

(Check all that apply.)

9. Are you accessing Framingham Heart Study (FHS) data?*

Yes
No

10a. Does the Data contain information collected from human research subjects?*

Yes
No

10b. Does the Data contain any identifiers, individually identifiable health information or protected health information (PHI)?*

Yes
No

Please provide your IRB protocol number.*

IRB Documentation*

Please upload applicable IRB documents (e.g., BU IRB approval letter)

Max. file size: 100 MB.

11a. Is the Material derived from humans?**

Yes
No

11b. Has the use of the Material been submitted to the BU IRB?*

Yes
No
N/A

12. How will you fund the research to be conducted under this Collaboration?*

Please provide grant/award number, if applicable.

13. Do you anticipate that any inventions will be developed by you from this Collaboration?*

Yes
No

Please discuss in as much detail as possible.*

14. Other than PHI, do you anticipate sending any Confidential Information as a part of this Collaboration?*

Yes
No

15. Do you plan to publish the results of the research Collaboration?*

Yes
No

Please provide a brief description of your plan.*

16. Does the External Party indicate that any of the following restrictions or limitations will be applied to your activities under this agreement? Please check all that apply.*

Not Applicable
Prior approval for dissemination/publications
Restrictions on access or participation by foreign nationals
Export control restrictions [International Traffic Arms Regulations (ITAR), Export Administration Regulations (EAR), Nuclear Regulations]

Principal Investigator Certification: I certify that the information I have provided about this project is accurate. Furthermore I certify that I will direct this project in compliance with Boston University policies, and with all applicable laws and regulations.

Signature*

Date*

Upload any relevant documentation (e.g., Word version of draft agreement from external party, IRB approval letter, etc.) here:

Drop files here or

Accepted file types: pdf, doc, docx, xls, xlsx, Max. file size: 100 MB.

Email

This field is for validation purposes and should be left unchanged.

Unfunded Collaboration Research Agreement (CRA)

Instructions

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Principal Investigator Certification: I certify that the information I have provided about this project is accurate. Furthermore I certify that I will direct this project in compliance with Boston University policies, and with all applicable laws and regulations.

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