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Center for immunobiology New Core User Form

Please complete the form below. Once the form is submitted and reviewed, someone from the center will be in contact to further discuss your needs. For more information about training and scheduling instruments please visit our Policy and Procedures webpage and click on the Center for Immunobiology SOPs. If you have any questions about the form please contact immunobiology@med.wmich.edu

Printable Version

Principle Investigator Contact Information

Investigator Contact Information

First Name

Last Name

Institution Name:

Department:

Position Title:

E-mail Address:

Phone Number:

Address Information

Address info

Street Address

Street Address 2

City/Town

State/Province

ZIP/Postal Code

Core Users and/or Additional Personnel Information

- Person One -

User1

First Name:

Last Name:

E-mail:

Phone Number:

- Person Two -

User2

First Name:

Last Name:

E-mail:

Phone Number:

Please indicate all WMed core equipment for which you are requesting access. Briefly describe how equipment will be used to further your research goals.

equipment

Please indicate if any of the following are present in specimens you would bring into to the WMed core. Choose all that apply.

Specimen List

Bacteria

Yeast

Genetically Engineered Cells

Virally Transformed cells (EBV, etc.)

Human Cells

Infectious Agents

Virus

Tested for Mycoplasma - Results Positive

Tested for Mycoplasma - Results Negative

Recombinant DNA

Radioactive Material

Does not apply

Other

Questions, comments and/or concerns?

concerns

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