Submission Form

Please answer the following questions and submit this questionnaire to us. Your answers will help us select appropriate experimental parameters, schedule diffractometer time efficiently, and may aid in the structure solving process. All Fields must be Filled out. If you do not have any information for a field place the text "none" in the contents of the field.

If you believe anything in your submission to be incorrect after completion, please do not "submit" again. To remidy this Please email The Xray Crystallography Lab and any modifications to your submission can be applied at your request.

General Information
Student Name		Student Phone
Student Email		Grant Number (XXXXXXX)
Research Director Name (Last name Only)		Research Director Phone

Sample Information
Chemical Formula

Draw possible structures: (if more than one give % confidence in structure in box labeled Structure comments below) Press button under drawing area when finished activate your structure. A list of coordinates should appear in the box below the button. Ring templates can be found by pressing the cardfile button at the top of the drawing area. If your structure contains charged species, please note the right charge information in the comment below.

Structure Comments. Please comment about any charges within this structure.

Chirality Chrial, a single enantiomer Chiral, Racemic Mixture Non-Chiral

Are the Crystals Sensitive to?

Air		Moisture
Heat		Light
Loss of Solvent

How were the Crystals Grown?

List ALL the solvents used in preparation and crystallization

Prioritization Information
How complete of a structure do you require for this compound?	Unit Cell Determination Only Full Structural Analysis
Please rate the urgency of the results on this 10 Point Scale.	1 2 3 4 5 6 7 8 9 10
	10 - Most Urgent
	1 - Whenever you get to it

Additional Comments

WAIT..... Are you sure that Everything is correct? If so, proceed with your submission.