2018-2019 School Year Mobile Lab Request

Please fill out all portions of this request form.  Once received YNS will contact you for shipment dates and details.  
Please complete all areas of the form for the lab(s) being requested. Thanks!
Teacher Information
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used as the primary communication method
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(1) pGLO Mobile Lab Request

Please select the date you would like each lab. If you are not requesting the lab in the question, just leave the date blank. When selecting supplies from Nebraska EPSCoR, please only select the materials you need so we can get these materials to as many teachers as possible.

Used to send appropriate supply amount
pGLO equipment needed:



Please select only the equipment you need
pGLO consumables needed:







Please select only the consumables you need
(2) Restriction Enzyme Digestion and Analysis of Lambda DNA Mobile Lab Request
Used to send appropriate supply amount
Restriction Digest & Lambda DNA equipment needed:





Please select only the equipment you need
Restriction Digest & Lambda DNA Consumables needed:







Please select only the consumables you need
(3) PCR: Alu Insert on locus PV92 Chromosome 16 Mobile Lab Request
Used to send appropriate supply amount
PCR equipment needed:






Please select only the equipment you need
PCR consumables needed:






Please select only the consumables you need
Demographics: Overall total of students participating in lab(s) selected?

Used for reporting purposes

Add all of the students participating in the labs
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Mobile Lab Information
Have you ever used Nebraska EPSCoR Mobile Labs in the past?

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