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Advanced Tissue Resource Center
MGH - Charlestown Navy Yard
B114, 2725D
114 16th Street
Charlestown, MA 02129
TEL 617.726.6389
FAX 617.724.2659
Advanced Tissue Resouce Center
User Access Form
Please fill out the ENTIRE form. You will be unable to schedule appointments until you have done so.
User Information
Name:
Your position:
Faculty
Post-doc
Technician
Other:
Grad student
Email:
Tel:
Fax:
Institution:
Department:
Building:
Room number:
Address:
City
State:
NeuroDiscovery Center Member?
Zip:
No
Yes
To become a member, please visit: http://www.neurodiscovery.harvard.edu/registration.html
(membership is free & members are entitled to discounts on services)
Principal Investigator:
PI Email
Financial Information
Financial contact:
Tel:
Email:
Fax:
Project Information
Title of current project:
If your project concerns neurodegeneration or neuro repair, please indicate the disease: (Please note,
this will not limit your access to the facility.)
Alzheimer's
Parkinson's
MS
Huntington's
ALS
Other neurodegenerative disease:
Other non-neurodegenerative disease:
If your project is not directly focused on a neurodegenerative disease, how is it related to
neurodegeneration or neuro repair?
Brief research summary:
Resouces of Interest
LCM
Bioanalyzer
RT-PCR
Luminex
Consultation
Requested Resources
Starting material for LCM:
If human tissue, provide IRB protocol #:
Desired cell population:
Staining method:
Antibodies & flourophores to be used:
Plan to analyze:
RNA
miRNA
DNA
Protein
Harvard NeuroDiscovery Center AGREEMENT
As a user of the Advanced Tissue Resouce Center, I agree to acknowledge the ATRC and
NeuroDiscovery Center in any publications resulting from the performance of the research project
described herein. I also agree to abide by the Harvard NeuroDiscovery Center's Guiding Principles and
the ATRC fee policy in my utilization of the facility.
User Signature:
DATE:
Print Form
To send electronically, by checking this box you agree to the terms and conditions described
above.
Submit by Email