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NORC Molecular Mechanisms Core Services Request for Core Use Investigator: Date of Request: Campus Box: Phone: Fax: E-mail: Summary of Project: Funding Source: PI: IRB or IACUC protocol Number: Approval date: _______ Services Requested a. Genomics Sub-Core: (Circle tests required) Assay: Q-RTPCR Microarray (mouse) Microarray (human) DNA sequencing Details of Request: b. Cell Biology Sub-Core: (Circle tests required) Details of Request: Revised 1/12/2011 Confocal Imaging Fluorescence Imaging - Widefield Laser Microdissection FACS Tissue Processing H&E Staining Immunohistolgy Consultation prior to submission of application Molecular Mechanisms Genomics Sub-Core Phone # Fax # E-mail 763-2782 763-0261 [email protected] 763-2779 763-0260 [email protected] Michael Salbaum, Ph.D. Cell Biology Sub-Core David Burk, Ph.D. Please return completed form to: Michael Salbaum, Ph.D., Director, by email Please remember to acknowledge the NORC on all publications, grants, etc. Under Acknowledgements add: This work was partially supported by a NORC Center Grant # 1P30 DK072476 entitled “Nutritional Programming: Environmental and Molecular Interactions” sponsored by NIDDK. Approval: Revised 1/12/2011 Date: Priority: