The YSU-S&CIF X-Ray Facility, Ward Beecher Science Hall, Room 5026, (330) 941-7105 Single Crystal Submission Form Please carefully fill in all the fields and include a printout with your labeled sample. For easy archiving please also send a copy of this word document to mzeller@cc.ysu.edu Sample Code: Date: Submitting Person: e-mail: Research Group: e-mail: YSU Room # or Non YSU Address Phone: Air Sensitive? Moisture Sensitive? Radiation Sensitive? Temp. Sensitive? Cryst. Solvents: Solvent Loss Possible? Exp. Molec. Formula: Exp. Moiety Formula: Purity (%) or Other Charac. Elemental Anlaysis: Methods: Microsoft Word Summary and Ortep plots required (upon request only)? Chemdraw Sketch of Synthetic Procedure (include all reagents and solvents used): Chemdraw Sketch of Proposed Structure (3D drawing of expected isomer for chiral compounds): Other Notes: Copies of this form can be downloaded at http://www.as.ysu.edu/chem/scic/SingleCrystalSubmissionForm.doc, http://www.as.ysu.edu/chem/scic/YSU-Users.html, or http://www.as.ysu.edu/chem/scic/Contact.html