ICANalytic : Application Form

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CytometryCell sorting
Cell analysis
autonomous user

1. Applicant details

Principal investigator *
Laboratory, institution *
PI phone * Email *
ICAN member *Yes No
Co-I details: *

2. Project details

Project title *
Summary of project from which samples originated
Proposed project (up to 500 words)
Assistance for experimental set up *Yes No

3. Original study details

Funder of original project *
Preliminary data obtained *
Type of data available for the samples *

4. Sample details
Sample type (PBMC, tissue, cell line, plasma, serum, culture supernatant…) *
Sample origin (human, animal species…) *
Number of samples for profiling *
Sample volume available *
Containers used for sample storage *
Conditions of sample storage (-80°C, -20°C, 4°C, under nitrogen, under argon, …) *
Duration of storage *
Number of freeze-thaw cycles *
For plasma, anti-coagulant added to the samples *
Nature and amount of preservatives added to the samples *
Are the samples known to be hazardous (e.g. infectious and parasitic organisms; presence of radioactive substances)? *
Is the study covered by ethical approval?Yes No
For human studies, are there donor consent forms?Yes No