Request for Equipment Training

Please fill out this form if you would like to use the equipment in the NIC@HMS or Systems Biology Microscopy Facility (SBMF) for your research.

If you want to take a workshop course in the NIC@HMS, this is the wrong form! Please fill out the form at: http://nic.med.harvard.edu/forms/workshop.html

Before filling out this form, please be sure to review our access policy and usage fees at http://nic.med.harvard.edu/access/index.html.

Your Full Name: *

Your Email Address: *

Please use your Harvard email address, not a yahoo, gmail or other email address. If you do not have a Harvard email address and you are not listed in eCommons, we will need to email your PI to varify your position.

Your Phone Number: *

Your Principle Investigator (PI): *

Your PI's Email Address: *

Your Position: *

Your Department: *

Your Lab Building & Room Number: *

Where is your lab located?: *

What techniques are you interested in using at this time?: *

Please describe your specimen: *

Are your specimens ready to image, or are you still preparing them?: *

Ready to image

Probably ready within a week

Probably ready within a few weeks

I'm planning ahead

Your answer will not delay your hearing back from us!

Please mark all that apply to your specimen: *

Fixed

Live

Need to timelapse (collect images of live specimen to make a movie)

Requires temperature control during imaging (i.e., mammalian cells)

Need to collect z-series (multiple focus planes of one field of view)

I'm not sure yet

Please list any specific fluorophores (if any) you will be using: *

Do you plan to quantitate fluorescence intensity values?: *

Yes

Maybe later

I don't know

Any additional information you would like to add?: