Molecular Interaction Facility
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Permission for Accessing Facilities
You
must
fill out this form in full and return it to Traci Ireland in 415, ACRC in order to use the Molecular Interactions Core Facility.
Compete and submit this form online, or
download
the MS-Word version and fax it to (501) 526-5934
Information About Principal Investigator
User Name:
User Email Address:
Phone/Pager (User):
User Fax:
Primary Investigator:
Department:
Lab Address:
Slot:
Phone (P.I.):
P.I. Fax:
P.I. Email Address:
Billing Detail
Business Administrator:
Department:
University Address:
Slot:
Phone:
Fax:
Budget Number:
Expiration Date:
Information about Resources
Title of Project:
Title of Grant:
Funding Source**:
Grant Number:
Is this funding source peer-reviewed?:
Yes
No
Additional Comments
**Indicate whether funding is either (1)requested with this preliminary project, (2) pending OR (3)funded.
Users of the core agree to acknowledge data acquired by the core in publication in the acknowledgement section of paper or by co-authorship, whichever is applicable.
