Mycoplasma Screening Request Form

The presence of mycoplasma in your cell line can affect the integrity of your entire experiment. The EMSS performs weekly mycoplasma screenings on Tuesdays with results by Wednesday. Simply fill out the request form and drop off your samples in the refrigerator in common equipment room 0964 before 10:00 on Tuesday.

Please provide the account information below.

Name: *

Date: *

P.I.: *

Email Address: *

Phone Number: *

Grant Number:

Account Number: *

Agency:

Project Title:

Business Manager Name:

Business Manager Phone:

Cell Line 1: *

Cell Line 2:

Cell Line 3:

Cell Line 4:

Cell Line 5:

Cell Line 6:

Cell Line 7:

Cell Line 8:

Cell Line 9:

Cell Line 10:

Cell Line 11:

Cell Line 12:

Cell Line 13:

Cell Line 14:

Cell Line 15:

Cell Lines Submitted: *

Please enter the total number of cell lines you are requesting to be tested. The number entered must match the number of cell line fields that are entered above. If you have more than fifteen cell lines to submit, please submit the first 15 and then start a new form for the remainder.

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Mycoplasma Screening Request Form