Sample information form

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Please provide the information requested below. This will help us to determine if we can safely handle your samples. We cannot start work on your experiment before this information has been provided.

What type of experiment is this?

What is the aim of the imaging experiment? What information are you trying to obtain? How many images are required?

How many samples do you have?

Safety of your sample: which organism, pathogens, dangerous chemicals (fixatives/drugs) etc. are used?

Please attach a relevant paper or image if available

Attach file

No files are currently attached.

PhD student

Postdoc

Other

If ‘other’, please specify:

Supervisor email (student/postdoc only, n/a if PI)

Which containment level are the samples prepared at?

Are nanoparticles used?

Is this medical research for tax purposes?

Does this sample involve human or animal tissue (including blood)?

Full name

Company or university

Yes

Privacy notice

The information on this form will be used to determine protective measures required to handle your sample and to charge for the time used for your experiment. We will store the information in this form and your contact details. We may contact you to request clarification. We will not use the data for any other purpose. By submitting this form you confirm that you have supplied accurate information to the best of your knowledge.

The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University's Data Protection webpages provide further information on your rights and how the University processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at infocompliance@warwick.ac.uk.

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