In order to utilize the services of the MDRTC Morphology and Image Analysis Core on a recharge basis, it is necessary to provide the following information. The various services provided by the Core are described on the attached sheets. 

Principal Investigator _______________________________ 
Telephone ___________________________ 

Department _______________ 
Campus Address and Box Number
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________ 

Project Funding Agency and Grant Number _______________ 
Account Number ___________________ 

Grant Title
_________________________________________________________________ 

Total Grant Award Period,
From _____________________________To __________________________ 

Total Amount Awarded ______________________ 

Administrator of Account __________________
Telephone _____________________________________ 

Administrator Address and Box Number
_________________________________________________________________ 

Briefly describe the project for which the services of the Core will be required
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________ 

Describe the relationship of your research to diabetes, endocrinology or metabolism
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

Indicate the services that will be required from the Core 
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________ 

If training of your personnel by the Core is required, give details 
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________ 

The MDRTC must provide the NIH with periodic reports of Core use by Center Investigators. By signing this application, the Principal Investigator agrees to provide the MDRTC with information concerning publications and other research funding that has resulted from the use of the Morphology and Image Analysis Core. 

Signature of Principal Investigator ______________________________ 

Date ______________________________ 

Please return the completed and signed application to: Dr. John Williams, MIA Core Director, Department of Physiology, 7744 Medical Science II 0626, University of Michigan Medical School. After a preliminary review of your application, Dr. Williams or one of the Associate Core Directors will contact you to arrange an appointment to discuss your application in more detail.

Application Approved: 

_______________________________ Date ________________ 
John A. Williams, M.D., Ph.D. 
MIA Core Director 

_______________________________ Date ________________ 
Christin Carter-Su, Ph.D. 
Associate Director, MDRTC 

APPROVAL NO.______________