Flow Cytometry and Immune Monitoring (FCIM):                      Service Request Form
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Email *
Name (First and Last) *
Name of PI (First and Last) *
USC ID (type "NA" if applicable) *
Department/School or Institute *
BUA Protocol Number *
List type(s) of material for cell analysis and/or sorting (e.g., species, tissue origin). *
What is the source of the cells (animal, humanized mouse, primary human, or established human cell line)? *
Required
If the material is human derived, was it screened for HIV, Hepatitis B, and Hepatitis C? If YES, please provide details on  *
If YES, please provide details
Are cells transduced, infected, or altered in any way? *
If YES, were they transformed using EBV, HTLV-1, adenovirus, retrovirus, lentivirus herpesvirus, or rabies virus? If vector is not listed, please provide.
Have cells undergone fixation? *
If YES, what is the fixative and how long was the fixation period?
Which instrument(s) will be used? *
Required
What biosafety level is required for these cells? *
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