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/^((29([-\/])02\3(\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00)))|((((0[1-9]|1\d|2[0-8])([-\/])(0[1-9]|1[012]))|((29|30)([-\/])(0[13-9]|1[012]))|(31([-\/])(0[13578]|1[02])))(\11|\15|\18)\d{4}))$/

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/^(((\d{2}([13579][26]|[2468][048]|04|08)|(1600|2[048]00))([-\/])02(\6)29)|(\d{4}([-\/])((0[1-9]|1[012])(\9)(0[1-9]|1\d|2[0-8])|((0[13-9]|1[012])(\9)(29|30))|((0[13578]|1[02])(\9)31)))) (\d|[0-1]\d|[2][0-3]):[0-5]\d$/

/^(?!\.)((?!.*\.{2})[a-zA-Z0-9\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF!#$%&'*+\-/=?^_`{|}~\d]+)(\.[a-zA-Z0-9\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF!#$%&'*+\-/=?^_`{|}~\d]+)*@(?!\.)([a-zA-Z0-9\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF\-\.\d]+)((\.([a-zA-Z\u0080-\u02AF\u0300-\u07FF\u0900-\u18AF\u1900-\u1A1F\u1B00-\u1B7F\u1D00-\u1FFF\u20D0-\u214F\u2C00-\u2DDF\u2F00-\u2FDF\u2FF0-\u2FFF\u3040-\u319F\u31C0-\uA4CF\uA700-\uA71F\uA800-\uA82F\uA840-\uA87F\uAC00-\uD7AF\uF900-\uFAFF]){2,63})+)$/i

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/^[-+]?[0-9]*,?[0-9]+([eE][-+]?[0-9]+)?$/

/^($0[2-8]$|0[2-8])\s*\d{4}\s*\d{4}$/

/^(?:$?([2-9]0[1-9]|[2-9]1[02-9]|[2-9][2-9][0-9]|800|811)$?)\s*(?:[.-]\s*)?([0-9]{3})\s*(?:[.-]\s*)?([0-9]{4})(?:\s*(?:#|x\.?|ext\.?|extension)\s*(\d+))?$/

/^((((\+44|0044)\s?\d{4}|$?0\d{4}$?)\s?\d{3}\s?\d{3})|(((\+44|0044)\s?\d{3}|$?0\d{3}$?)\s?\d{3}\s?\d{4})|(((\+44|0044)\s?\d{2}|$?0\d{2}$?)\s?\d{4}\s?\d{4}))(\s?\#(\d{4}|\d{3}))?$/

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/^\d{5}(-\d{4})?$/

iPSC & Fibroblast Information Collection Form

Thank you for considering to share samples with NCRAD. Your contribution is an important addition to the research community. As an added benefit to sharing your samples with NCRAD, the quality control results will be returned to you once your lines have been processed by the IUGB.

Please complete the survey below to provide information about the samples you plan to share. Thank you!

Researcher Name

Institution

Address Line 1 (Street Address)

Address Line 2 (Apt, Ste, Unit)

City

State

Zip / Postal code

Phone number

Email address

Additional Contact Name

Additional Contact Email address

Grant Number(s) that supported line development

Note: We request that investigators submit 3 vials per iPSC and fibroblast line. This ensures the lab has extra vials in the event of a QC measure failure. Sending less than 3 vials could result in additional requests for any vials that fail QC.

Note: If you are depositing fibroblast-derived iPSCs, please send original fibroblast lines in the same shipment.

Are you returning samples generated from NCRAD samples?

Yes

reset

I would like to deposit (check all that apply):

iPSCs

Fibroblasts

iPSC - Number of iPSC lines you want to deposit

1-5

6-10

11-15

16-20

21-25

26-30

31-35

36-40

41-45

46-50

51+

reset

iPSC - Number of iPSC lines you want to deposit: 51+ (Please specify)

iPSC - Mutation Info

Note: Exact mutation information will be required before depositing.
Please send sequencing data for validation (if available).

Wild Type

Mutation

Sporadic AD

iPSC - Mutation Type

APOE4

APP

c9orf72

MAPT

PGRN

PSEN1

PSEN2

TREM2

Other

iPSC - Mutation Type - APOE4
What genotype?

* must provide value

iPSC - Mutation Type - Other (Please specify)

* must provide value

iPSC - Mutation Source

Patient-derived

Genetically engineered

iPSC - Do you have isogenic lines?

Yes

reset

iPSC - Please deposit any isogenic lines, if available.

iPSC - Use of feeders layers?

Yes

reset

iPSC - Media

mTesr1

Tesr2

mTesr E8

mTesr 3D

Nutristem

StemMACS iPS-Brew XF

Unknown

Other

iPSC - Media - Other (Please specify)

iPSC - Substrate

Matrigel

Vitronectin

Laminin

None

Unknown

Other

iPSC - Substrate - Other (Please specify)

iPSC - Freezing media

DMSO

Cryostore

mFreSR

Gibco PSC Cryopreservation

Synth-a-Freeze

Unknown

Other

iPSC - Freezing media - Other (Please specify)

iPSC - Passage number at freeze (range)

1-15

16-20

21-25

26-30

31+

Unknown

iPSC - Number of cells frozen per vial

< 500,000

500,000-1,000,000

>1,000,000

Unknown

iPSC - Reprogramming method

Episomal

mRNA

Retroviral

Lentiviral

Sendai Virus

Unknown

Other

iPSC - Reprogramming method - Other (Please specify)

iPSC - Passaging Method

Dispase

Collagenase

Accutase

EDTA

Unknown

Other

iPSC - Passaging Method - Other (Please specify)

iPSC - CO2 Conditions

5% CO2

Unknown

Other

iPSC - CO2 Conditions - Other (Please specify)

iPSC - O2 Conditions

Atmospheric

Hypoxic

Unknown

iPSC - O2 Conditions - Hypoxic - What % O2?

iPSC - Do you have Mycoplasma testing for iPSCs?

* must provide value

Mycoplasma free

Not tested/unknown

iPSC - Please upload iPSC mycoplasma testing documentation.

Upload file

iPSC - How many requests have you received for your iPSC lines in the last 12 months?

1-5

6-10

11-15

16-20

21-25

26-30

31+

reset

iPSC - Number of requests:

iPSC - Please upload relevant iPSC protocol(s).

Upload file

iPSC - Do you have an additional iPSC protocol to upload?

Yes

reset

iPSC - Please upload relevant iPSC protocol(s).

Upload file

iPSC - Have any of these iPSC lines been published on?

Yes

Unknown

reset

iPSC - Please provide the PubMed link(s) to publication(s):

Expand

iPSC - Please provide any other relevant information about your iPSCs you would like us to know.

Expand

Fibroblast - Number of fibroblast lines you want to deposit

1-5

6-10

11-15

16-20

21-25

26-30

31-35

36-40

41-45

46-50

51+

reset

Fibroblast - Number of fibroblast lines you want to deposit: 51+ (Please specify)

Fibroblast - Mutation Info (Fibroblast)

Note: Exact mutation information will be required before depositing.
Please send sequencing data for validation (if available).

Wild Type

Mutation

Fibroblast - Mutation Type (Fibroblast)

APOE4

APP

c9orf72

MAPT

PGRN

PSEN1

PSEN2

TREM2

Other

Fibroblast - Mutation Type - APOE4
What genotype?

* must provide value

Fibroblast - Mutation Type - Other (Please specify)

* must provide value

Fibroblast - Media

RPMI 1640 + FBS

DMEM + FBS

DMEM/F12 + FBS

Unknown

Other

Fibroblast - Media - Other (Please specify)

Fibroblast - Freezing media

growth medium + DMSO

growth medium + glycerol

Unknown

Other

Freezing media - Other (Please specify)

Fibroblast - Passage number at freeze (range)

1-5

6-10

11-15

16-20

21-25

26+

Unknown

reset

Fibroblast - PDL at freeze (range)

1 to 9

10 to 19

20 to 29

30 to 39

40 to 49

50+

Unknown

reset

Fibroblast - Number of cells frozen per vial

< 500,000

500,000-1,000,000

>1,000,000

Unknown

Fibroblast - Passaging Method

Trypsin EDTA

Unknown

Other

Fibroblast - Passaging Method - Other (Please specify)

Fibroblast - CO2 Conditions

5% CO2

Unknown

Other

Fibroblast - CO2 Conditions - Other (Please specify)

Fibroblast - O2 Conditions

Atmospheric

Hypoxic

Unknown

Fibroblast - O2 Conditions - Hypoxic - What % O2?

Fibroblast - Do you have Mycoplasma testing for fibroblasts?

* must provide value

Mycoplasma free

Not tested/unknown

Fibroblast - Please upload Fibroblast mycoplasma testing documentation.

Upload file

Fibroblast - How many requests have you received for your fibroblast lines over the last 12 months?

1-5

6-10

11-15

16-20

21-25

26-30

31+

reset

Fibroblast - Number of requests:

Fibroblast - Please upload relevant Fibroblast Protocol(s).

Upload file

Fibroblast - Do you have an additional Fibroblast protocol to upload?

Yes

reset

Fibroblast - Please upload relevant Fibroblast protocol(s).

Upload file

Fibroblast - Have any of these fibroblasts been published on?

Yes

reset

Fibroblast - Please provide the PubMed link(s) to publication(s):

Expand

Fibroblast - Please provide any other relevant information about your fibroblasts you would like us to know.

Expand

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.