This form is for hCD1a, hCD1b, hCD1c, hCD1d, and mCD1d tetramer requests and for CD1d ligand requests

The request form is used for review of the request.

** Note: One request form per tetramer

Important! Your request will not be considered unless all the fields on this form are filled.

(Click here to find out when the Tetramer Resource Committee meets again to review requests.)

Be sure to register with our reagent program if you are a new client.

(Click here to download the Registration Form)

Contact and Shipping Information

Investigator's Name:
Title:
Institution:
Department:
Street Address:
City, State, ZIP
Telephone Number:
Fax Number:
E-mail: (Please note: our system can only accept one email address here on this form.)
Shipping Company / Account No.
All reagents will be shipped to the above address which cannot be a post office box.

Please Note:

1. Both human and mouse CD1 reagents are generated with their species-matched b2m light chains.

2. Unloaded CD1d of the same species and labeled with the same fluorophore will be provided with all approved PBS57-loaded CD1d requests for use as a negative control.

3. The lyophilized OCH and GSL-1 powders contain Tween 20, histidine, and sucrose to make them water-soluble (0.2 mg/mL).

4. We can not distribute PBS-57 by itself. It is only available from this facility loaded into CD1d reagents.

CD1d Reagent Information

Allele requested
Ligand requested
If you choose other CD1d ligands, please provide us with a brief description of the ligand origin and purity in the rationale and supporting data field.
Desired LABEL for tetramer:
- If other, requester must send label.

Funding and Project Information

FOR NEW AND REFILL REQUESTS: PLEASE COMPLETE ALL FIELDS BELOW (failure to complete all fields will delay review and approval process). (NIH funding is not a requisite for requesting tetramers)

Title of Current Research Grant(s) or Contract supported by NIH for which tetramers will be used:
Grant or Contract Number (if any):
Please list the staff that will be using this reagent (include collaborators):
Positive Control to test the requested tetramer(s): Yes No Please provide a description of your positive control. Results from T cell lines, clones or hybridomas are preferred, but assays using T cell bulk cultures are acceptable for immunodominant responses. The data can be submitted as a journal article citation or assay results from the requestor's lab. Please list the journal citations here or email any figures necessary for Tetramer Resource Committee to evaluate your request to TRC@niaid.nih.gov - please include the name of the PI, as it appears on the on-line Tetramer Request form in this email.
Research Abstract: This abstract should include a brief description of the research project, experimental system, and how the tetramer reagent will be used to facilitate the research project. (limit: 1000 words)

If this is a refill request, please also answer the following questions.

Have you submitted a feedback form on your original order?
If you have not provided feedback to the NIH Tetramer Facility Manager, approval of your order could be delayed.
Please go to our online feedback form and submit a complete report.
Please provide your reason for requesting additional tetramer. (If the tetramer no longer works, please provide a brief description of how the tetramer was stored and explain the experimental conditions in which the tetramer failed to stain, including the positive and negative controls that were used in the study.)

Last updated February 12, 2007 (EVR)