APPLICATION FORM FOR FREE CMGI SCANS

UC Davis PIs who wish to use the CMGI's services for in vivo or ex vivo imaging may be allowed free scanning time, particularly if the scans are to obtain preliminary data for a grant proposal and if the investigator lacks sufficient funding to pay for the scans. The amount of free scan time will depend on the imaging modality. Six scans, or a pair of scans (pre- and post- intervention) on 6 animals, will be granted for microPET, microCT, MRI and ultrasound imaging. The investigator will only be charged at cost for the isotope (chosen from MicroPET Tracers Available) or for any contrast agents. For optical (bioluminescent or fluorescent) imaging, up to 2 hr of free imaging time will allowed for the PI to obtain sufficient preliminary data for a grant application.

PRINCIPAL INVESTIGATOR

Name
Salary Title
Department
Phone (xxx-xxx-xxxx)
Email Address
Additional Contact Name

PROJECT INFORMATION

Project Title

Brief description of proposed study, explaining the aim and emphasizing the imaging requirements:


*Are the scans necessary to obtain preliminary data for a grant application?
Yes No

If so, when do you intend to submit the application, and to which funding agency?


If the scans are not to obtain preliminary data, please give a justification for your request for free scans:


*Are you currently funded for any imaging studies?
Yes No


If Yes, please complete the following:

Title of Grant
Expiration Date

Please explain why you require free scans and why the proposed study cannot be done with existing funding:

APPLICATION FORM FOR FREE CMGI SCANS

PRINCIPAL INVESTIGATOR

PROJECT INFORMATION