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MIT.nano Sample Registration
MIT.nano Sample Registration
You must have JavaScript enabled to use this form.
General Information
Last name:
First name:
Email address:
MUMMS username:
You must set up a MUMMS account to use MIT.nano.(
https://nanolms.mit.edu/mumms/registration.html
).
Principal Investigator (PI):
PI's Email address:
Institution:
Department:
Sample Information
Use this form for each new biological sample you would like to bring into the MIT.nano facility for specimen preparation and/or imaging. To register multiple samples you will need to submit the form more than once. We will work with you to establish procedures for your specimen that ensure safety for all users of the facility.
What facility do you plan on bringing your biological sample to?
Select all that apply.
Atomic Force Microscopy
Cryo-EM
Electron Microscopy
Optical Spectroscopy
Surface Analysis
X-Ray Diffraction & Imaging
Sample name
Have you previously registered this specimen material and its components for use at MIT.nano?
Yes
No
Thank you for registering your sample!
After you receive sample approval, if you are working in the CryoEM facility, please proceed to the
CryoEM session request form
. For work in any other facility, please proceed to the
MIT.nano NEMO
for training requests.
Sample Details
Describe your sample as it will be brought to MIT.nano in general terms (less than 200 words):
Outline the overall goal(s) of the research in the space below. Include enough information to ensure the experiments' purpose and techniques used are understood. Please use general terms:
Is your sample an inorganic nanomaterial or contain inorganic nanomaterials (material with at least one dimension <100 nm)?
Yes
No
Please describe the nanomaterial:
Is your sample biological?
Yes
No
Does your sample have any hazards other than biological?
Chemical
Radiological
Other
Enter other types of hazards here
Select method(s) of waste disposal appropriate for your sample.
Please select all that apply.
Biowaste box
Chemically-contaminated solids
I will take waste back to my PI's lab.
Other
Please specify.
Please list the chemicals (full chemical names) contained in the waste:
Will your sample be fixed (frozen does not count as fixed per NIH Guidelines) before entering MIT.nano?
Yes
No
Additional Sample Information
Could you describe the procedure used to fix your sample?
Biological Sample Information
Will your sample already be frozen on a TEM grid prior to bringing it to MIT.nano?
Yes
No
N/A
Is your sample purified or crude?
Purified
Crude extract
Describe decontamination or inactivation method for your sample (e.g. 10% bleach, 70% Ethanol, etc):
What is the BioSafety Level (BSL) of your sample?
BSL1
BSL2
BSL2+
Please note: Our facility cannot handle BSL2+ samples.
Do you have a BRR?
Yes
I do not have a BRR
Please enter 3 digit BRR number.
Contact your MIT Biosafety Officer if you do not know your lab's BRR number.
Ensure MIT.nano is on your BRR's locations.
Please Check the following in regards to your sample as it enters MIT.nano:
Does your sample use Recombinant or Synthetic Nucleic Acid? (will you use or generate recombinant microorganisms, cells, animals, plants, etc.)
Use of Whole Animals or their Cells/Tissues, including invertebrates (C. elegans and others) or Insects (if you work with animals, invertebrates, insects, or cells/tissues from these organisms.)
Use of Plants
Use of Human Source Material
Human Embryonic Stem Cells (hES) or materials derived from hES Material
Induced Pluripotent Stem Cells (iPS Cells)
Microorganism Use (if you work with viable microorganisms/viruses)
Use and/or Storage of Toxins
I understand that checking this box indicates that I have answered all of the above questions to the best of my knowledge and that I agree to only bring properly approved materials into MIT.nano. I will follow all policies and procedures outlined in MIT.nano documentation and training. If found out of compliance, I understand this may result in loss of access to MIT.nano facilities.
I understand
