Fields marked with an * are required. In cases where the information is not applicable, please state N/A.
Please read the information on nominating diseases and tumour types before you complete this form. Also before you begin, consider the following points:
1. Is your proposed disease or tumour type already included in the 100,000 Genomes Project? Click here to check.
(If you would like to propose a change to the eligibility criteria for one of the rare diseases, go to the Rare Disease Eligibility Change Form).
2. For a rare disease nomination, is the aetiology of your disease complex and polygenic?
3. For a tumour type nomination, are there large scale sequencing programmes already being focusing on the tumour type (e.g. TCGA or ICGC)?
4. Are there any sections of this form you currently cannot complete? (review the questions)
If your answer is ‘yes’ to any of the above points, your nomination is not likely to be taken forward for consideration.
If your answer is ‘no’ to the above points, and you feel there is a strong case for your proposed disease or tumour type to be included in the 100,000 Genomes Project, click 'next'.
Please complete all fields with as much detail as possible. If you experience any difficulties when using this form or need more information, contact us at firstname.lastname@example.org
You cannot save this form, so we recommend drafting and saving your answers elsewhere. You can download the questions in a word document.
Section 1. Nominating Organisation or Group
Section 2. Contact information
Section 3. Disease information