ICANalytic : Application Form

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LaboratoireCytometry
Cell sorting
Cell analysis

Analysepre-analytic services
post-analytic services
bioinformatic

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)

3. Original study details

Funder of original project *
Publications resulting from original project
Preliminary data obtained *
Type of data available for the samples *
Was the original project peer-reviewed *Yes No

4. Sample details
Sample type (plasma, serum, faeces, cells, tissue,...) *
Number of samples of the original study *
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)? *
Type of subjects or animals involved *
Is the study covered by ethical approval?Yes No
For human studies, are there donor consent forms?Yes No

5. Timing and Restrictions
Details of specific assays requested *
Preferred start date for the analysis *
Are there restrictions over publication and IP ownership? (please provide details) *