HostSeq Data Application Form

HostSeq Databank Application Form

Please submit the form below to apply for access to the controlled data in the HostSeq databank. Qualified applicants must be independent researchers who are affiliated with a legal entity (e.g. university professor, researcher in a private company, independent researchers able to apply for federal research grant, etc.)
Main applicant information
Name*

First NameLast Name
Title, Position, Affiliation
Email*
example@example.com
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Short Biography (200 words max.)

0/200
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)
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.
Name

First NameLast Name
Title, Position, Affiliation
Email*
example@example.com
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
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.)*

0/300
Background and rationale of the proposed project (300 words max.) *

0/300
Brief explanation of why the HostSeq databank is the ideal resource to answer your research question(s) (150 words max)*

0/150
Brief description of methods and how the HostSeq Database data will be used (600 words max)*

0/600
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)*

0/300
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
Lay summary (150 words max.)

0/150
Estimated timeline of the project, in months
Funding for the project, if applicable
Data Requested
What data would you like to request?*
Phenotypes - Demographics

Sex, gender, ageEducation, employmentHousing, householdPregnancy
Phenotypes - Comorbidities

Immunological (HIV, Autoimmune, rheumatologic diseases, organ transplant)Respiratory (COPD, asthma, cystic fibrosis, sleep apnea)Cardiovascular (hypertension, PVD, MI, stroke, heart failure, arrhythmias, history of PCI or bypass)Genitourinary/ Metabolic (diabetes, CKD, pancreatic diseases, gallbladder diseases)Neurological (dementia, other neuropsychiatric conditions)Cancer (type, location, treatment, age of diagnosis)
Phenotypes - Assessment

Hospitalization status (admission, discharge dates)ICU use (admission, discharge dates)Ventilation supportCOVID-19 test (result, test date)COVID-19 vaccination status (number of doses, brands, dates)Virus/Bacteria testHome medications
Phenotypes - Complications

COVID-19 complications (inventory of 25 complications)
Phenotypes - Treatment

Ventilation (prone positioning, NO inhalation, tracheostomy, ECMO, dialysis, vasopressors)Medications (antivirals, antibiotics, corticosteroids, antifungal, colchicine, chloroquine, etc.)
Phenotypes - Laboratory Results

Laboratory test results (inventory of 31 tests)
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*

Cancelof
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)

Cancelof
Collaborators

Collaborators are anticipated research staff (co-investigators or students) who will have access to the HostSeq datasets in order to work on the research project. 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.
Do you have collaborators?*
Authorized Person 1

First NameLast Name
Title, Role, Affiliation
Email
example@example.com
Authorized Person 2

First NameLast Name
Title, Role, Affiliation
Email
example@example.com
Authorized Person 3

First NameLast Name
Title, Role, Affiliation
Email
example@example.com
Should be Empty:

HostSeq Databank Application Form

Main applicant information

Publications

Institutional Representative

Research Project

Lay summary of the project

Data Requested

Ethics

Collaborators