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NMR Sample Submission Form
for San Joaquin Delta College Students
Name (please print):
_________________________________
Date:
_________________________________
Phone Number:
_________________________________
Email Address:
_________________________________
Sample ID:
_________________________________
Supervising Professor:
_________________________________
Supervising Professor’s email:
_________________________________
If Submitting a Solution:
Deuterated Solvent? _________________________________
If Submitting a Solid or Neat Liquid:
Mass?:
_________________________________
~Concentration
Suggested Solvent
_________________________________
_________________________________
Proposed Structure
Requested Experiments
(Circle desired experiment)
1H
13C{1H}
31P{1H}
13C
DEPT
COSY
HSQC
HMBC
NOESY
Other Nuclei (29Si, 11B, 19F, 119Sn, etc.)
____________________________________________________
Other Experiments Requested:
____________________________________________________
13C
UDEFT
TOCSY
Do you have a specific spectrometer request?
YES or NO
** If yes then specify here which spectrometer and why.
Does your sample require special handling precautions? YES or NO
** If yes please specify on the back necessary precautions & any hazards we may face handling your sample.
Do you want the sample held for pick-up?
YES or NO
** If yes then the sample will be held for a maximum of 2 weeks unless alternative arrangements are made.