Application form for Phenotypic screening

Principal investigator contact information
Mandatory for EU users, otherwise 21% Dutch VAT
Collaborator(s) contact information
Billing address
If the billing address is different from the address above, please enter the address below.
Shipping address
User access
Confidentiality
If your application requires an NDA, a user account through which you can upload your NDA will be created.
Project information
Please state in one sentence the main research question and the research question the data could answer
Please state name here if applicable and attach file to upload
Project/application details
Please specify the target protein and protein family (according to the uniform identifier at http://www.uniprot.org)
Read-out
(probe, fluorescent protein, etc.)
If yes please specify below.
Ethical screening
In order to identify the policy/regulation to govern the undertaking of the project (e.g. NL-Openscreen code of Practice for Research on Human Participants, Animals, Medicines for Human Use (Clinical Trials) following NL regulations), please answer the following questions. If any of the questions are answered with YES in this section, the project will require a full ethical review before it is approved for selection.