Nanowell Cytometry - New User Form

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Name (First Last) *

Email *

Name of PI/Lab & Name of institute *

Biohazard Level *

Service requested *

Cell type(s), average size(s) (um), count(s), % viability: (Ex. "Lymphocyte 12 10,000 90%") *

Any known infectious/pathogenic agents? *

If yes, please list the agents. If no, enter NA *

Has the infectious/pathogenic agent been deactivated? *

If yes, please list the deactivation method. If no, enter NA *

Are samples primary cell lines? *

If yes, were the donors screened for blood borne pathogens? *

Are samples established human cells? *

If yes, were the donors screened for blood borne pathogens? *

Have the cells been fixed? *

If yes, please list the fixative(s). If no, enter NA *

Were the cells transformed using a virus (Eg. EBV, Herpes, etc.) *

If yes, please list virus. If no, enter NA *

Were the cells genetically engineered or used with rDNA? *

If yes, how were the cells engineered? If no, enter NA *

Was a virus or a viral vector system used? *

If yes, please list the virus or the vector system (Eg. Adenovirus, Lentivirus, Retrovirus, etc.). If no, enter NA *

Fluorophores, excitation (nm), emission (nm): (Ex. "AlexaFluor405 401/20 421/50") *

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