FSU College of Medicine - Flow Cytometry Facility New User Registration

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Flow Cytometry Laboratory
New User Registration

This form is for all users of the Flow Cytometry Facility.
Items marked with a * must be completed.

First Name*

Middle Initial

Last Name*

Department*

Building*

Office Phone*

Home Phone

Are you a COM Faculty or Staff Member?
Yes No

Principal Investigator*

Room number*

Lab Phone

E-mail address*

Project Title*

Describe the project*

Cell Type (e.g. Mouse leukocytes, human PBI, etc.)*

Straining reagents you intend to us*

Are the cells* Fresh Fixed

Do the samples contain any hazardous or infectious agents* Yes No
If yes, list them.

List any known human pathogen

Are samples are from a human donor? Yes No

If no, you may stop at this point and press the submit below.

If yes, continue here.

Where they screened for infection with hepatitis B or C or human immunodeficiency virus (HBV, HCV, and HIV)?
Yes No

If no, you cannot proceed with sorting experiments. All freshly-isolated human cells must be derived from donors screened for exposure to the above infectious agents. For questions or comments, contact at (850) 645-1465.

Do you have Human Subject Approval for the collection of human cells? Yes No

If no, you cannot proceed with sorting experiments. All studies of human material must be have approval or review. For questions or comments, contact at (850) 645-1465.

If the samples are covered by a human pathogen registration document (HPDR), provide the number:

If the samples are covered by a recombinant DNA registration document (RD), provide the number:

Confirmation Code:* Enter the code exactly as you see it.

Flow Cytometry Laboratory New User Registration

Flow Cytometry Laboratory
New User Registration