DNA Learning Center
www.urbanbarcodeproject.or
g
Phone: (516) 367-5170
Fax: (516) 367-5182
Email: urbanbarcode@cshl.edu
Cold Spring Harbor Laboratory
1 Bungtown Road
Cold Spring Harbor, NY 11724
Urban Barcode Project Footlocker Kit Application Form
Date
Teacher Name
Teacher Email
Teacher Phone
School Name
School Address
School Phone
Grade of Students
Teams using this kit
Types of Samples and
Number of DNA extractions
(Please indicate the number of DNA
extractions you plan to perform for each
sample type)
I would like this kit by...
(choose days between Tuesday and Friday)
Do you have any equipment/
materials for this lab?
(Please enter X for answer)
# teams: ________ # students (total): ______
Project titles: ____________________________________
____________________________________
____________________________________
____________________________________
Plant
Algae
Fish
Insect
#______ Other animals (specify the type and #):
#______ Type:_____________________ #_______
#______
#______
Date:
Yes ________ No __________
If you have equipment/materials, please complete page 2.
_________________________________________________________________________________________
FOR OFFICE USE ONLY
Pick-up Date
Return Date
Fee
DNA Learning Center
Cold Spring Harbor Laboratory
1 Bungtown Road
Cold Spring Harbor, NY 11724
www.urbanbarcodeproject.or
g
Phone: (516) 367-5170
Fax: (516) 367-5182
Email: urbanbarcode@cshl.edu
If you have any of the following equipment/materials at your school, please indicate it
below with a “Y”.
Equipment/Materials
DNA extraction reagents (silica extraction method)
Pestles for grinding samples in microcentrifuge tubes
Microcentrifuge
Waterbath
Thermometer
Gel electrophoresis chambers / power supplies
Gel electrophoresis reagents (agarose, buffer etc.)
UV transilluminator
Digital camera and hood for gels
Thermal cycler (if “Y”, what model?)
Tubes for thermal cycler
Small micropipettors (10 µl)
Medium micropipettors (100 µl)
Large micropipettors (1000 µl)
10 µl tips
100 µl tips
1000 µl tips
1.5 ml microcentrifuge tubes
Tube racks for 1.5ml tubes, PCR tubes, etc.
DNA stain (e.g. SYBR green, CarolinaBLU, etc.)
DNA marker (e.g. 100bp ladder, pBR322/BstNI)
Sterile distilled water
Gloves
Enter “Y” below if you have any of
these materials.