CVS Antibody Production Injection Questionnaire

"*" indicates required fields

Your name*

First Last

Your WSU email address*

ASAF number*

Species*

Date of requested injection/blood collection*

Injection type*

Injection route*

Number of antigens*

Please enter a number from 1 to 3.

For more than 3 antigens, please submit an additional form.

Injection/Blood Collection Details

Please complete the following for each antigen. Note that the total volume per animal will be evenly divided over the number of injection sites indicated in the ASAF.

Name of antigen*

Amount of antigen (mg, µg, ng)*

List amount per animal, include unit.

Adjuvant*

Number of animals*

Injection volume per site (µL)*

Number of injection sites (per animal)*

Total volume injected (µL, per animal)*

Date antigen:adjuvant prepared*

Who prepared the antigen:adjuvant?*

Injection Details (Antigen 2)

Name of antigen*

Amount of antigen (mg, µg, ng)*

List amount per animal, include unit.

Adjuvant*

Number of animals*

Injection volume per site (µL)*

Number of injection sites (per animal)*

Total volume injected (µL, per animal)*

Date antigen:adjuvant prepared*

Who prepared the antigen:adjuvant?*

Injection Details (Antigen 3)

Name of antigen*

Amount of antigen (mg, µg, ng)*

List amount per animal, include unit.

Adjuvant*

Number of animals*

Injection volume per site (µL)*

Number of injection sites (per animal)*

Total volume injected (µL, per animal)*

Date antigen:adjuvant prepared*

Who prepared the antigen:adjuvant?*

Do you need a blood sample to check titer(s)?

Yes

Requested blood sample volume (mL)