LERNER RESEARCH INSTITUTE
Genomics Core
http://www.lerner.ccf.org/services/gc/
LRI Genomic Medicine Institute, NE5-253, 216 - 444 0974
HiSeq Sequencing Request Form
Date Submitted:
P. I. Name:
P. I. email if outside CCF:
Activity number/P.O.#:
Department:
Date Completed:______________________________
Submitter Name: _____________________________
CCF user e-mail:
@ccf.org
Non-CCF user e-mail:
Phone:
Contact Core Manager Dr. Osee Sanogo, sanogoy@ccf.org with any questions.
Sample type: (mRNA; smallRNA; High Conc. DNA; Low Conc. DNA) _________________________________
Sample Preparation Requested
HiSeq (check one box only)
Multiplex Instructions (check
(check one box only)
one box only)
1 x 50nt  2 x 50nt PE read
No multiplex -1 sample/lane
mRNA‐SEQ/Poly-A selection
 1x100nt  2 x 100nt PE read
2 samples per lane
RNA-SEQ/RiboZero

nt  2 x 125nt PE read
3 samples per lane
Small RNA (microRNA)
 1x 150nt  2 x 150nt PE read
4 samples per lane
Exome-SEQ
 1x 250nt  2 x 250nt PE read

samples per lane
gDNA-Whole Genome
Other:
User prepared library*
Other *
Run Type
Sample Submission Instructions: Please submit all samples on dry ice or on ice if you’re close to the Genomics Core
DNA-Seq, please provide 1-5 μg of genomic DNA, RNA-Seq, please provide 1-3 μg of total RNA, Small RNA: 2-5 μg of total RNA,
ChiP-Seq: 50ul of 5ng-10ng DNA
Sample
Sample Name
Concentration
Volume
Organism
Comments
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*Use additional pages if necessary
I, (PI name), declare that the RNA/DNA samples submitted to the Core do not contain any agents
(biological or otherwise) that can be harmful to those processing the samples.