533562586 Service Request -- COBRE-PSF Bio-NMR Laboratory 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. Do not use this form if you reserve instrument time and run your own experiments. Use this form for everything else, but do not submit samples until they are requested. 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. Please complete ALL sections. Save the document as “Lastname - BNMR Work Request” (without quotes) and submit it electronically to Dr. Asokan Anbanandam, Director, COBRE Bio-NMR Lab <asokan@ku.edu>. 1. Submission Date: 2. BNMR Work Request # (leave blank) 3. Project Cost Estimate: (leave blank) 2. Submitter Information (PI / Faculty / equivalent) NAME Phone Dep't. E-mail Indicate location: ( )KU ( )KUMC ( )KSU ( )WSU ( )Other_______________________________ 3. Laboratory Contact Person (research asst./assoc.) NAME Phone Dep't. E-mail 4. Please tell us about your request. (Type responses under the headings below). 4.1. Training on NMR operation or data interpretation. ( ) No. ( ) Yes. For whom, on what subject(s)? 5. NMR analysis. What do you want to learn about your sample by using NMR? Do you have an established or preferred protocol that we should use, or will we need to develop one? 6. Sample Information. Please be as explicit and complete as possible. (Type "X" in parenthesis). ( ) Protein? provide Molec. Wt. if known: ( ) Peptide? provide sequence if known: ( ) Other? (provide details or call 785-864-3746 to discuss): Labeling: ( ) Unlabeled; ( ) 15N; ( ) 15N,13C; ( ) 15N,13C,2H; ( ) Other. Explain. (Call if radioactive). Sample concentration (include units): Solvent / co-solvents: Buffer? (which buffer, conc., pH): Other salts? Identify and give conc. Air sensitive? yes ( ), no ( ). Preferred temperature for data collection = ( ˚C). (range = +15 to +50 ˚C). Hazards, special precautions? ( ) No. ( ) Yes, explain: NMR Experiment to be run: ( ) homonuclear; ( ) heteronuclear; ( )1D; ( )2D; ( )3D; ( )4D; ( )T1 ; ( )T2 ; ( ) heteronuclear NOE ( ) CPMG (dynamics at µsec-msec motion). ( ) Protein-Ligand binding/kinetics. (Ligand = small molecule or macromolecule) page 1 of 2 533562586 7. ( ( ( ( Reason for this 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). 8. 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. ( ) 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) 9. If 8.A is checked above, please enter only your COBRE Sub-Award grant number below. If either 8.B or 8.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 grant 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 BNMR Lab 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 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