Request for UW HIV Information System (UWHIS) Data, Specimens, and Referral Services

Investigators requesting specimens or referral services, please contact the UW HIV Specimen Repository Manager, Michalina MontaƱo, who will assist you in completing this form. (206-744-4630 - micham@uw.edu)

Investigators requesting clinical data may contact the UWHIS Research Assistant, Matthew Jackson, for assistance. (206-685-7791 - mkj5@uw.edu)

Please allow two weeks for fulfillment of each submission; for requests needed in a shorter amount of time, the Data Manager, Peggie Griffith, may be contacted to discuss expedited service. (206-744-3683 - peggieg@uw.edu)

Grant Application PI Information
Grant Application PI Information
Study Investigator Information

If you are filling this form out on someone else's behalf, please use their information, not your own.

NIH Reporting

Please provide the following information required by CFAR for NIH reporting.

Contact Information
Grant Information
Grant PI Information
Grant PI Information
Study Subjects
Data Elements

Please list the discreet data elements that you are requesting for each study subject/specimen.

Specimen Information
Recruitment/Referral Information
Signature