Directorate of Laboratory Medicine
Cellular Pathology: General Office Page 1 of 4
Cell-Path-Man-Form-017
Version: 2
Application for Molecular Pathology Node Proximity Lab/Cellular
Pathology Laboratory Support
Please return completed form to [email protected]
Applications are reviewed every Wednesday. Any applications received after Tuesday 9am will be
reviewed the following week.
PART 1: Support required
1.1 Name, and Position, of person applying for support:
This will be the name, and the position, of the individual applying for the support (or the PI of the
Project)
1.2 Title of Proposal & University BH Number (if applicable)
The Title of the proposed work; as well as the corresponding Newcastle University “BH” number
(if applicable)
1.3 Summary of research project (the box will expand to your typing. Please limit to 300 words)
A brief summary of what the proposed project is regarding.
1.4 Details of work required. Please include estimates of the volume of work or use of equipment
required e.g. numbers of cases.
Examples of this may include:
 Processing/embedding/microtomy (include estimate numbers where possible)
 Staining eg H&E, specials, IHC, RNA scope (slide numbers where possible)
 IHC optimisation (antibody names required)
 TMA construction (Donor block numbers where possible)
 Vectra use
1.5 Requested start date of project and the expected completion date (subject to capacity)
Please give dates where possible.
1.6 Is REC approval required for the work? If YES please provide:
1.6.1 REC Reference Number
The REC approval reference number should be entered here.
If REC is still awaiting approval then this should be stated here.
(if REC approval is pending please state this)
A Laboratory form containing data is NOT a controlled document
Valid on day of print only:
The Proforma is a Controlled document
Document details i.e. Update responsibility, Ultimate approver, Active date and Review date are held in Q-Pulse
If you recognise an inaccuracy or can suggest an improvement, please raise a Change Request on Q-Pulse
Directorate of Laboratory Medicine
Cellular Pathology: General Office Page 2 of 4
1.6.2
Cell-Path-Man-Form-017
Version: 2
Has a copy of the REC letter been included?
(No work will commence unless a copy of the REC letter is attached)
YES
NO
1.7 Is NUTH R&D approval required for the work? If YES please provide:
1.7.1 NUTH R&D number
The NUTH R&D approval reference number should be entered here.
If NUTH R&D is still awaiting approval then this should be stated here.
1.7.2 Is there a collaborative agreement with the Trust for this work?*
Please provide details of what the collaborative agreement is:
Please provide any evidence of any collaborative agreements that might exists with the Trust for
this Project.
Example:

An agreement between the University and Trust which includes a Trust-employed CoInvestigator
NB. Please provide evidence that this work is outside the scope of VAT eg
The project is Trust led; an agreement between the Newcastle University and the Trust exists for
a Trust-employed Co-Investigator or the funding for project is held within a trust account
1.8 Do you have a RES number for this project? If YES please provide:
1.8.1 RES number
The RES approval reference number should be entered here.
If RES is still awaiting approval then this should be stated here.
PART 2: Funding
2.1 Is there existing funding to support this request? If YES please provide details of:
2.1.1 Where the funds are located (examples Newcastle University Account, NuTH account)
Please be aware that a Purchase Order will be required before any work will commence
The location of the funds that will be used to pay for the project
Example:
 Newcastle University C account
 Trust RES account
2.1.3 Grant Holder
A Laboratory form containing data is NOT a controlled document
Valid on day of print only:
The Proforma is a Controlled document
Document details i.e. Update responsibility, Ultimate approver, Active date and Review date are held in Q-Pulse
If you recognise an inaccuracy or can suggest an improvement, please raise a Change Request on Q-Pulse
Directorate of Laboratory Medicine
Cellular Pathology: General Office Page 3 of 4
Cell-Path-Man-Form-017
Version: 2
2.1.4 Sponsor
The person/organisation that is sponsoring the project
Example:
 GSK
 CRUK
2.2 Please provide details of who to send invoice to (include name, address and email):
This will be a name and contact number of the individual who we will forward all Invoices too.
Please provide:
 Name
 Address
 Contact Number
 Email Address
PART3: Strategic fit
3.1 Does the proposed project meet the objectives of the Molecular Pathology Node? i.e does it
facilitate/contribute to the implementation of stratified medicine into clinical practice? If so, please
describe how:
Although not exclusive, the Node welcomes applications in the following areas:

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



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Industrial studies evaluating molecular pathology techniques or equipment
Biomarker studies with potential for translational outcomes and high quality academic
outputs
Studies that translate biomarkers into clinical practice
Image analysis studies that use the Vectra and its infrastructure
University/Trust collaborative projects relating to stratified medicine
Graduate projects that require automated immunohistochemistry
University/ Trust collaborations that require input from a clinical pathologist
Clinical trainee projects on molecular pathology
*As a result of changes to HMRC rules in August 2013, VAT must now be applied to all project work
undertaken in the Cellular Pathology Department unless evidence that the work is outside the scope of
VAT can be provided.
The Node is working closely with Trust Finance and the Newcastle Joint Research Office to support
colleagues in providing evidence that work carried out in the Node Proximity Lab is outside the scope of
VAT where appropriate. Such evidence could include for example, a collaboration agreement between
the University and Trust which includes a Trust-employed Co-Investigator.
A Laboratory form containing data is NOT a controlled document
Valid on day of print only:
The Proforma is a Controlled document
Document details i.e. Update responsibility, Ultimate approver, Active date and Review date are held in Q-Pulse
If you recognise an inaccuracy or can suggest an improvement, please raise a Change Request on Q-Pulse
Directorate of Laboratory Medicine
Cellular Pathology: General Office Page 4 of 4
Cell-Path-Man-Form-017
Version: 2
If you are unsure whether your work request is outside the scope of VAT, please contact Amanda
Randall,
Assistant
Financial
Services
Manager,
NUTH
on
0191
213
7061
or
[email protected] for additional guidance.
A Laboratory form containing data is NOT a controlled document
Valid on day of print only:
The Proforma is a Controlled document
Document details i.e. Update responsibility, Ultimate approver, Active date and Review date are held in Q-Pulse
If you recognise an inaccuracy or can suggest an improvement, please raise a Change Request on Q-Pulse