HostSeq Databank Application

Canada’s national platform for genome sequencing

Section A: Main Applicant

Qualified applicants must be independent researchers who are affiliated witha legal entity (e.g. university professor, researcher in a private company, independent researchers able to apply for federal research grant, etc.)

Full Name

Title

Position or Role

Affiliation

Full Address

Institutional Email

Alternate Email of Main Applicant

Phone Number

Short Biography (200 words Max)

Publications

Provide three relevant publications with full bibliographic references, for which you were an author or co-author

Publication 1

Authors

Title

Date of Publication

PMID (if applicable)

Publication 2

Authors

Title

Date of Publication

PMID (if applicable)

Publication 3

Authors

Title

Date of Publication

PMID (if applicable)

Section B: Institutional Representative

An institutional representative is a qualified representative of a legal entity who has the administrative power to legally commit that entity to the terms and conditions of the data access agreement. Examples of institutional representatives include, but are not limited to: a Vice-President Research, a Research Director, or a Contracts Officer for the entity.

Full Name

Title

Position or Role

Affiliation

Full Address

Institutional Email

Section C: Research Project

This section should describe the background, objectives and methodology of your research project. Please ensure to clearly explain how the HostSeq datasets you wish to access will be used and the expected outcome/impact of the research project.

Project Title

Research questions and aims (300 words max)

Background and rationale of the proposed project (300 words max)

Brief explanation of why the HostSeq databank is the ideal resource to answer your research question(s) (150 words max)

Brief description of methods and how the HostSeq Database data will be used (600 words max)

Expected outcome and impact of the research, including how you intend to disseminate the results of your research project (e.g. peer reviewed publications and/or your approach to open science) (300 words max)

Lay summary of the project. The lay summaries of approved projects are posted on the HostSeq website. As these summaries target the general public, please describe your project how you would to a friend who is not an expert. Scientific terminology should therefore be described or defined in lay terms. In addition to describing the background and objectives of your research project, clearly explain how the datasets you wish to access will be used (150 words max)

Estimated timeline of the project, in months

Funding for the project, if applicable

Section D: Data Requested

Select the data you would like to request

Whole Genome Sequence (WGS)

WGS and Phenotype (from the list below, select all variables that apply to your research)

Section E: Ethics

PLEASE NOTE: HostSeq is not responsible for the ethics approval/monitoring of individual research project and bear no responsibility for the applicant’s failure to comply with local/national ethical requirements.

Please provide an approval letter from your IRB or Ethics Committee formally designated to approve and monitor research involving humans OR a declaration of exemption

Expiration Date

Please upload the Data Collection Form listing the data variables you have been REB-approved to collect for this project (this form will generally be part of the documents submitted for REB approval)

Section F: Collaborators

Are there anticipated research staff (co-investigators or students) who will have access to the HostSeq datasets in order to work on the research project, Yes/No (If Yes, please provide names, 3 max, below)

Yes

No

Please Note: Co-investigators, collaborators or students at other institutions should not be included in this list. They will have to submit a separate Application for Access to HostSeq Controlled Data.

Authorized Personnel

Full Name

Title

Position or Role

Affiliation

Institutional Email

Authorized Trainee

Full Name

Title

Degree

Affiliation

Full Address

Institutional Email

Authorized Trainee

Full Name

Title

Degree

Affiliation

Full Address

Institutional Email