MICROARRAY SAMPLE SUBMISSION FORM
MINOTECH-Genomics Facility
MICROARRAY SAMPLE SUBMISSION FORM
User Name:
PI Name:
Institution:
IMBB member:
YES
NO
User Mail:
PI Mail:
Tel no:
Date:
INVOICE INFORMATION
Name:
(Όνομα)
Institution:
(Ινστιτούτο)
Address:
(Διεύθυνση)
VAT Registration No:
(ΑΦΜ)
Tax Office:
(ΔΟΥ)
Accounting Office tel:
(Τηλ. Λογιστηρίου)
Account number:
(Πρόγραμμα)
Genomics Facility Use:
Date Received: _____________________________ By:________________________________________
Microarray Start Date: ___________________
Additional Notes/Comments:
_____________________________________________________________________________________
MICROARRAY SAMPLE SUBMISSION FORM
SAMPLE INFORMATION
Sample Type:
gDNA
Total RNA
mRNA
Other:______________________________________
Sample Type &Species: __________________________________________________
Organism:
Prokaryotic
Eukaryotic
Number of samples submitted: _________________________
Concentration Measured By:
Nanodrop
Qubit
Bioanalyzer
Pico Green
Other:_________________________
EXPRESSION ARRAYS
Please select one of the following options
Affymetrix Hybridization Service only (User provides labeled material for array hybridization)
Type: Labeled aRNA/cRNA
Labeled ss cDNA
Full Service Target Labeling and Hybridization (Users submits RNA)
Other: Was RNA DNase treated?
Yes
No
GeneChip Information
GeneChip Type:
3’ IVT
Human Genome U133 Plus 2.0
Mouse Genome 430 2.0
Human Genome U133A 2.0
Mouse Genome 430A 2.0
PrimeView™ Human Gene Expression
Rat Genome 230 2.0
Other: ___________
Whole Transcriptome
Gene ST 1.0
Gene ST 2.0
Exon 1.0
Transcriptome 2.0
Other: __________________
MICROARRAY SAMPLE SUBMISSION FORM
OTHER ARRAYS1
GeneChip Type:
SNP Genotyping & CNV Analysis
genome-wide human SNP 6.0
CytoScan HD Array
Pharmakogenetics
DMET™ Plus Solution
Gene Regulation Analysis
Human Promoter 1.0R Array
Human Tiling 1.0R Array Set
Human Tiling 2.0R Array Set
Other (please specify): _______________________________
1 Other arrays
are less common in the Facility, therefore you should contact us
for availability before starting an experiment
MICROARRAY SAMPLE SUBMISSION FORM
Sample Information
Sample
ID
Original Sample
Name
Conc.
(ng/μL)
Vol.
(μL)
Diluted in (e.g. Condition/type (e.g.
H2O, TE etc)
control or treatment)
Sample 1
Sample 2
Sample 3
Sample 4
Sample 5
Sample 6
Sample 7
Sample 8
Sample 9
Sample 10
Sample 11
Sample 12
Sample 13
Sample 14
Sample 15
Sample 16
Sample 17
Sample 18
Sample 19
Sample 20
IMPORTANT!




All samples must be clearly labeled with the sample name, P.I.'s last name, and date.
All samples should be accompanied by their QC documents (Bioanalyzer graphs, gel electrophoresis
images, etc). If not, the Facility will perform QC with an extra cost
All samples should be accompanied by a copy of the filled submission form
Data will be removed from the Facility after three months of the release date
Other comments:
_____________________________________________________________________________________
_____________________________________________________________________________________
Signature