RBL Immunology Assay Request Form

RBL Immunology Assay Request Form

Please submit your request using this form. Submit special instructions in the comment box (if any)

Requestor Name (First Last)*

Requestor Email*

Laboratory PI Name*

Duke Fund Code*

Be sure the Requestor is linked in CoreResearch@Duke to the PI and the specific project fund code.

Program/Project Affiliation*

Select

DCVC#

(If Applicable)

GVCRC #

Duke RBL Animal Models Unit study number (RAMU#):

(If applicable. Format RAMU-XXXX)

Assay Type*

*MSD assays can only be performed in a 96-well format.

Select

Sample Species*

If human samples, make sure there is no protected health information (PHI) on the box, samples or manifest. Note that dates directly related to individual (e.g. sample collection dates) are considered PHI.

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NHP Species*

Select

Isotype(s)*

Select or enter value

Will the antigen be provided?*

Select

Please provide details:

Specify coating conditions (concentration and buffer)

Sample Type*

Select

Sample Safety Information*

Select

Explain*

IBC Registration Number & Title

Number of Samples*

Sample Dilution*

(Specify preferred dilution factor for samples in assay)

Select

Sample Replicates*

Select

Protein/Target Antigen*

Select

HA - Subtype/Strain Name*

(Note: Numbers in parenthesis indicate assigned bead region)

Select or enter value

NA - Subtype/Strain Name*

(Note: Numbers in parenthesis indicate assigned bead region)

Select or enter value

Isotype (Beads Conjugated To Antigen In-House)

Select or enter value

Kit Provided*

Select

Kit Manufacturer*

Select

Kit Name & Catalog Number*

List of Analytes To Be Detected

Comment

Number of Plates To Read

Plate Layout Uploaded*

Upload plate layout in the sample manifest field below

Intended Date of Assay Run

Will internal controls be provided?

Provide Instrument settings & standard concentrations data sheet (if lot specific)*

Upload a copy in the field below

Please confirm you will provide 10 mLs of culture supernatant.*

File Upload

Drag and drop files here or

Please confirm Sample Manifest uploaded*

Do you want your left over samples (if any) back?*

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Send me a copy of my responses

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