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Please provide the following information. This information is intended to ensure that we know exactly what you want us to do. The cost estimate we provide will be based on this information.
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Type directly onto to this Microsoft Word document; it will expand as you type, but please be concise, and please use 10 point Arial font for readability.
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Then Save the document under a unique filename and submit it electronically to Dr. Philip Gao, Director,
COBRE Protein Purification Core Lab <gao@ku.edu>.
1. Work Request Submission Date:
2. Submitter Information (PI / Faculty / equivalent)
NAME Phone
Dep't. E-mail
Indicate location: ( )KU ( )KUMC ( )KSU ( )WSU ( )Other_______________________________
3. Laboratory Contact (research asst./assoc.)
NAME Phone
Dep't. E-mail
4. Description of work requested.
4.1) Tell us exactly what you want us to provide; i.e. define the "deliverable" or "product" that you expect to receive from this work request. Examples might include: consultation, training, protocol development, cloning, mutagenesis, expression system development or improvement, large or small scale protein expression and/or purification, and/or Biacore binding studies.
4.2) Tell us what criteria the product must meet (quantity, concentration, buffers, purity, functionality, etc.).
5. Methods. Do you have an established or preferred protocol that we should use, or will we need to develop one? If the product requested has been made before, please provide PDF copies of specific protocols or relevant literature methods with this form. Mention special precautions, if any.
6. Materials provided by Requestor. What will you provide - clones, plasmids, antibodies, reagents, chips, etc.? If nothing, so state. Are any of these items "precious" (extremely costly or in very limited supply)?
7. Personnel. Will personnel from your lab be involved in any of the work requested? If so, please explain how:
8. Reason for request.
How will you use the results? Please check one.
( ) Test a preliminary idea for a potential future project.
( ) Obtain preliminary data to support a new grant application in preparation.
( ) Increase/accelerate the productivity of a funded project in my lab.
( ) Other (please explain briefly below).
9. Please indicate ( X ) the source of support for the work being requested.
( ) A . COBRE-PSF Pilot Project Award
( ) B . Client requests a COBRE-PSF subsidy coupon (then check either B1 or B2 below).
NOTE: Coupons MUST be arranged and agreed upon IN ADVANCE of the project. page 1 of 2

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( ) B1.
Client has ≥ 1 major active grant (e.g., NIH R01, NSF, or similar).
( ) B2.
Client has limited or negligible resources (e.g. small grants only, no-cost extension, etc.)
( ) C . Other (please explain)
10. If either B or C is checked above , please provide ALL requested billing information below ( REQUIRED ).
Address Invoice(s) to (name) area code and phone #
Email address
Institution / Department
Mailing address / zip
Funding agency grant # or P.O.# grant ending date
-----------------------------TERMS AND CONDITIONS -----------------------------
1. Timing. Requests are generally processed in the order received. If there is any " special " urgency or timing consideration, such as a looming grant application deadline, please explain here in detail.
2. Authorship and acknowledgement policies.
These policies are available from each of the Core Lab websites at http://psf.cobre.ku.edu
. Submission of this work request indicates the client's awareness of and agreement to abide by these policies, and specifically the following:
2.1) Proper acknowledgement of the specific COBRE Core Lab and the COBRE gran t P30GM110761 on all publications reporting work done using COBRE facilities, AND
2.2) Possible authorship rights of Core Lab personnel arising from the work performed. It is our policy that
Core Lab personnel whose work enables a project to succeed deserve recognition as co-authors of the work.
2.3) For questions about this policy please contact Dr. Robert Hanzlik, Director, COBRE-PSF (rhanzlik@ku.edu).
3. Research support and billing information.
COBRE Core Labs operate on a fee-for-service basis. Core Lab rates are the same for all clients. The current fees are published at http://psf.cobre.ku.edu
. Fee subsidies (coupons) may be available in certain cases. In other cases, F&A surcharges may apply. Acknowledgement and authorship are not substitutes for payment of the costs of the research/service the cores provided.
The PPG guarantees to perform the work requested (i.e. to execute the client-provided or client-approved protocol) competently and faithfully and to document steps accurately, but it gives no guarantee of specific outcomes on research-like projects (defined as not a repeat of a known successful protocol). The Core Lab
Director will notify the Client when the project will start, and will furnish brief email updates at significant milestone events, plus a complete report at completion of the project. page 2 of 2