NORTH DAKOTASTATE
UNIVERSITY
FORENSIC DNA FACILITY
NDSU Forensic DNA Facility ▪ IACC Bldg, Room 326 ▪ 1320 Albrecht Blvd.▪ Fargo, ND 58102
Ph: 701.231.8670 ▪ Fax: 701.231.8324
Case Submission Form
Client Name:Client Case #: / FDF Lab #:
Victim: / Offense:
Suspect: / Date:
Please check one of the following:
Original Evidence Submission / Additional Evidence Submission
Please check one of the following:
Normal Processing / Rush Processing
Authorized Point(s) of Contact:
Name:Agency:
Title:
Telephone Number:
Fax Number:
Cell phone:
Email Address:
Address (Line 1):
Address (Line 2):
City:
State, Zip:
Brief description of case:
ADM Form 15Page 1
Version 1.0
3/15/2007
NORTH DAKOTASTATE
UNIVERSITY
FORENSIC DNA FACILITY
DNA Testing Requested (Please indicate for each item by placing an X in the appropriate box.)
Serology / DNA Testing / May we consume the sample?Item Number / Number of Items / Description of evidence / Blood Test / Semen Test / STR / Y-STR / Other
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
If you checked Other for any item above, please describe the requested testing below.
ADM Form 15Page 1
Version 1.0
3/15/2007
NORTH DAKOTASTATE
UNIVERSITY
FORENSIC DNA FACILITY
Please indicate below if the billing contact and address is different from the POC on page 1.
Name:Agency:
Title:
Telephone Number:
Fax Number:
Cell phone:
Email Address:
Address (Line 1):
Address (Line 2):
City:
State, Zip:
Please indicate below the Courier and Account Number to be used to return the evidence.
Courier:Account Number:
Case Authorization:
I hereby certify that the information provided above and on Page 1 and 2 of the Case Submission Form is accurate to the best of my knowledge. I understand that I will be charged for services according to the fee schedule that I have received. I authorize the NDSU Forensic DNA Facility to apply approved procedures in order to analyze the submitted evidence based on the experience of the analyst, nature and type of the evidence, or th e specific request made. Any procedural deviationswill be noted and reviewed and approved by the Technical Leader.Signature: / ______
Print Name:
Please submit a completed form with this evidence. All evidence items should be shipped to the address below via delivery that requires signature receipt. If evidence items are perishable, please ensure that the evidence is sent on dry ice.
Ship to: Forensic DNA Facility
NDSU IACC 334
1320 Albrecht Blvd.
Fargo, ND 58102
Phone: 701-231-8670
NDSU Forensic DNA Facility ▪ IACC Bldg, Room 326 ▪ 1320 Albrecht Blvd.▪ Fargo, ND 58102
Ph: 701.231.8670 ▪ Fax: 701.231.8324
EVIDENCE STORAGE/PACKAGING/SHIPPING PROCEDURES
STORAGE OF EVIDENCE SAMPLES PRIOR TO SHIPPING
Liquid blood must be kept refrigerated(not frozen).
Tissue (e.g. abortus, autopsy sample) must be kept frozen.
Swabs must be packaged individually in a paper container (e.g. manila envelope).
Dried stains must be packaged individually in a paper container (e.g. manila envelope).
Hairs must be packaged individually in a paper container (e.g. manila envelope).
Clothing/bedding/etc. must be packaged individually in a paper container (e.g. sack).
Slides must be packaged in a manner which protects against breakage (e.g. slide mailer).
NOTE: As a general rule, biological evidence should never be packaged in plastic except when the biological material is continually maintained in a frozen state for storage and/or shipping.
SHIPPING OF EVIDENCE SAMPLES TO NDSU FDF
Liquid blood (e.g. EDTA purple top Vacutainer) must be packaged in a manner which protects against breakage and then placed in a sealed container along with ice and/or cold packs sufficient to keep the blood cold for a minimum of 24 hours. The evidence must be shipped overnight by a carrier which provides appropriate security and item tracking information (e.g. Federal Express).
Tissue (e.g. abortus, autopsy sample) must be packaged in a manner which prevents potential leakage of liquid (e.g. sterile screw cap plastic tube) and then placed in a sealed container along with dry ice sufficient to keep the tissue frozen for a minimum of 24 hours. Should dry ice be unavailable then ice and/or cold packs may be used with the understanding that some degree of DNA degradation may occur. The evidence must be shipped overnight by a carrier which provides appropriate security and item tracking information (e.g. Federal Express, UPS, DHL).
Dried Stains/Swabs/Hair must be placed in a sealed paper container and the evidence must be shipped overnight by a carrier which provides appropriate security and item tracking information (e.g. Federal Express).
NOTE: PLEASE CONTACT THE NDSU FORENSIC DNA FACILITY WITH ANY QUESTIONS CONCERNING EVIDENCE STORAGE AND/OR SHIPPING.
ADM Form 15Page 1
Version 1.0
3/15/2007