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Mobile Lab Requests
Please complete all areas of the form for the lab(s) being requested. If not requesting a lab, please leave blank. Once received YNS will be in contact via email for shipment dates and details.
Teacher Information
First Name
*
Last Name
*
E-mail
used as the primary communication method
*
School Name
*
School Address
*
School City
*
School State
*
School Zip
*
How would you categorize your school?
Urban
Rural
Suburban
Other
Contact Phone Number
*
(1) pGLO Mobile Lab Request
pGLO Total Students:
Used to send appropriate supply amount
When would you like to receive the lab?
pGLO equipment needed:
Incubator
Water Bath
Mini Centrifuge
UV Lights
Please select only the equipment you need
pGLO consumables needed:
Reagents
Transformation Solution (Calcium Chloride)
LB nutrient broth
LB Agar
Petri Dishes
Inoculation loops
Microcentrifuge tubes
Disposable plastic transfer pipets
Please select only the consumables you need
(2) Restriction Enzyme Digestion and Analysis of Lambda DNA Mobile Lab Request
Digest Total Students:
Used to send appropriate supply amount
When would you like to receive the lab?
Restriction Digest & Lambda DNA equipment needed:
Water Bath
Mini Centrifuge
Gel Electrophoresis Chambers
Power Supply
Digital Micropipettes
Gel Staining Tray
Please select only the equipment you need
Restriction Digest & Lambda DNA consumables needed:
Restriction Enzymes
Other Reagents (buffer, marker, DNA, loading dye)
TAE Buffer
Fast Blast DNA Stain
Agarose powder
Floating foam Racks
Micro Test Tubes
Pipet Tips
Please select only the consumables you need
(3) PCR: Alu Insert on locus PV92 Chromosome 16 Mobile Lab Request
PCR Total Students:
Used to send appropriate supply amount
When would you like to receive the lab?
PCR equipment needed:
Water Bath
Mini Centrifuge
Digital Micropipettes
PCR Thermal Cycler
Gel Electrophoresis Chambers
Power Supply
Gel Staining Tray
Please select only the equipment you need
PCR consumables needed:
Reagents
Fast Blast DNA Stain
TAE Buffer
Agarose powder
Pipet Tips
PCR tubes
Micro test tubes
Please select only the consumables you need
Demographics: Overall total of students participating in lab(s) selected?
Used for reporting purposes
Overall Total Students
Add all of the students participating in the labs
*
Male
*
Female
*
White
*
Black/African American
*
Asian
*
Native Hawaiian/Pacific Islander
*
American Indian/Alaskan Native
*
Other
Hispanic/Latino(a)
*
Receiving Special Education Services
*
Mobile Lab Information
Have you ever used Nebraska EPSCoR Mobile Labs in the past?
Yes
No
*
How did you hear about Nebraska EPSCoR Mobile Labs?
*