**ADP SAMPLE REQUEST FORM**

Please review the appropriate sample and data policy before completing
this form. Accepting samples requires investigator(s) to fulfill certain
obligations. Failure to honor these obligations will prejudice future
sample applications.

**Date** (month, day, year):

**Investigator Name(s):**

If more than three investigators are involved, use the "proposed
research" space (item 6) to provide additional full names and addresses.
Please indicate which investigator will receive the shipment (must
include street address and room number if applicable-deliveries cannot
be made to a post-office box).

+-----------------+---------------+-------------+----+----------------+
| **INVESTIGATOR  | # First Name: | Middle      | #  |                |
| 1**             |               | Initial(s)  | La |                |
|                 |               |             | st |                |
|                 |               |             |  N |                |
|                 |               |             | am |                |
|                 |               |             | e: |                |
+-----------------+---------------+-------------+----+----------------+
| Organization:   |               | **De        |    |                |
|                 |               | partment:** |    |                |
+-----------------+---------------+-------------+----+----------------+
| **Street        |               |             |    | Is this the    |
| Address**:      |               |             |    | shipping       |
| (Required if    |               |             |    | address (Y/N)? |
| this is the     |               |             |    |                |
| shipping        |               |             |    |                |
| address: ADP    |               |             |    |                |
| will pay for    |               |             |    |                |
| shipping costs  |               |             |    |                |
| to deliver      |               |             |    |                |
| samples, but    |               |             |    |                |
| any duties      |               |             |    |                |
| levied by       |               |             |    |                |
| customs will be |               |             |    |                |
| the             |               |             |    |                |
| responsibility  |               |             |    |                |
| of the          |               |             |    |                |
| recipient)      |               |             |    |                |
+-----------------+---------------+-------------+----+----------------+
| City:           | **Stat        | **Postal    | ** |                |
|                 | e/Province:** | Code:**     | Co |                |
|                 |               |             | un |                |
|                 |               |             | tr |                |
|                 |               |             | y: |                |
|                 |               |             | ** |                |
+-----------------+---------------+-------------+----+----------------+
| **Phone:**      | **Fax:**      | **Email**   |    |                |
|                 |               | (required): |    |                |
+-----------------+---------------+-------------+----+----------------+

+-----------------+---------------+-------------+----+----------------+
| **INVESTIGATOR  | # First Name: | **Middle    | #  |                |
| 2**             |               | I           | La |                |
|                 |               | nitial(s)** | st |                |
|                 |               |             |  N |                |
|                 |               |             | am |                |
|                 |               |             | e: |                |
+-----------------+---------------+-------------+----+----------------+
| **              |               | **De        |    |                |
| Organization:** |               | partment:** |    |                |
+-----------------+---------------+-------------+----+----------------+
| **Street        |               |             |    | Is this the    |
| Address**:      |               |             |    | shipping       |
| (Required if    |               |             |    | address (Y/N)? |
| this is the     |               |             |    |                |
| shipping        |               |             |    |                |
| address: ADP    |               |             |    |                |
| will pay for    |               |             |    |                |
| shipping costs  |               |             |    |                |
| to deliver      |               |             |    |                |
| samples, but    |               |             |    |                |
| any duties      |               |             |    |                |
| levied by       |               |             |    |                |
| customs will be |               |             |    |                |
| the             |               |             |    |                |
| responsibility  |               |             |    |                |
| of the          |               |             |    |                |
| recipient)      |               |             |    |                |
+-----------------+---------------+-------------+----+----------------+
| **City:**       | **Stat        | **Postal    | ** |                |
|                 | e/Province:** | Code**:     | Co |                |
|                 |               |             | un |                |
|                 |               |             | tr |                |
|                 |               |             | y: |                |
|                 |               |             | ** |                |
+-----------------+---------------+-------------+----+----------------+
| **Phone:**      | **Fax:**      | **Email**   |    |                |
|                 |               | (required): |    |                |
+-----------------+---------------+-------------+----+----------------+

+-----------------+---------------+-------------+----+----------------+
| **INVESTIGATOR  | # First Name: | **Middle    | #  |                |
| 3**             |               | I           | La |                |
|                 |               | nitial(s)** | st |                |
| **(SHIPPING     |               |             |  N |                |
| LIAISON)**      |               |             | am |                |
|                 |               |             | e: |                |
+-----------------+---------------+-------------+----+----------------+
| **              |               | **De        |    |                |
| Organization:** |               | partment:** |    |                |
+-----------------+---------------+-------------+----+----------------+
| **Street        |               |             |    | Is this the    |
| Address**:      |               |             |    | shipping       |
| (Required if    |               |             |    | address (Y/N)? |
| this is the     |               |             |    |                |
| shipping        |               |             |    |                |
| address: ADP    |               |             |    |                |
| will pay for    |               |             |    |                |
| shipping costs  |               |             |    |                |
| to deliver      |               |             |    |                |
| samples, but    |               |             |    |                |
| any duties      |               |             |    |                |
| levied by       |               |             |    |                |
| customs will be |               |             |    |                |
| the             |               |             |    |                |
| responsibility  |               |             |    |                |
| of the          |               |             |    |                |
| recipient)      |               |             |    |                |
+-----------------+---------------+-------------+----+----------------+
| **City:**       | **Stat        | **Postal    | ** |                |
|                 | e/Province:** | Code:**     | Co |                |
|                 |               |             | un |                |
|                 |               |             | tr |                |
|                 |               |             | y: |                |
|                 |               |             | ** |                |
+-----------------+---------------+-------------+----+----------------+
| **Phone:**      | **Fax:**      | **Email**   |    |                |
|                 |               | (required): |    |                |
+-----------------+---------------+-------------+----+----------------+

**(1) ADP Expedition Name:**

**(2) I am a**

expedition participant

post-expedition investigator

**and I am requesting samples**

during the expedition

during the post-expedition moratorium

after the post-expedition moratorium

\(3\) If this is a supplement or revision to a previous request, please
provide the investigator names and date of the previous request:

**(4) Check all keywords in the categories below that apply to your
research:**

SPECIALTY:

+-------------+-------------+-------------+-------------+-------------+
|             | Magnetic    | Petrology   |             | Education   |
| Se          |             |             | G           |             |
| dimentology | Properties  |             | eochemistry |             |
+-------------+-------------+-------------+-------------+-------------+
| Structural  | Physical    |             |             | Other:      |
|             |             | P           | M           |             |
| Geology     | Properties  | aleontology | icrobiology |             |
+-------------+-------------+-------------+-------------+-------------+

TYPE OF MATERIAL:

+-------+--------------+------------------+-------------+-------------+
| Gas   | Sediments    | Metamorphic Rock | Vein        | Data        |
|       |              |                  | Material    |             |
+-------+--------------+------------------+-------------+-------------+
|       | Igneous      | Metalliferous    | Fluid       | Other:      |
| F     |              | (Ore) Deposits   | Inclusions  |             |
| luids | Rock         |                  |             |             |
+-------+--------------+------------------+-------------+-------------+

**(5) Please list the types of analytical data you will generate** (for
example, compound-specific δ^13^C, major-element bulk chemistry,
biostratigraphic, etc.) **and the methods that you plan to use** (XRD,
Microprobe, SEM, TEM, etc.)**.**

**(6) Please summarize the proposed research.** Briefly describe the
proposed project, including techniques of sample preparation and
analysis, roles of individual investigators, etc.

**(7) Please provide a brief list of your relevant publications.** The
list need not be exhaustive, but it should provide evidence of your
relevant expertise.

\(8\) Are you requesting(please check all that apply)?

  --------------- --------------- -------------------- --------------------
  Core Samples    To describe     To                   Sample Residues
                  cores at a      photograph/analyze   
                  repository      cores at a           
                                  repository           

  Pore-water      Cores for       Data                 Other:
  Splits          display                              
  --------------- --------------- -------------------- --------------------

Choose one of the following two sampling options:

It is ok to change sample positions by up to 10 cm.

It is not ok to change sample positions.

Provide a more detailed sampling explanation for your request if
necessary:

**Sample lists:**

# Table 1: Provide all the requested information

Estimated number of samples:

Location, Site, Hole, Sample Depth, Volume (cm^3^), Shape/Tool, and
Comments (optional)

**Example:** ..., 5 cc, sawn quarter-round

**(9 ) If you want to visit a repository, please directly contact the
U.S. Curator of ADP materials at that repository to schedule a time to
visit**. The list of repositories is available at
http://nai.arc.nasa.gov/adp/ppp.cfm