DNA Sequencing Core
University of Michigan
Affymetrix Full Service Sample Submission Form: Gene Chip/Atlas
Date:
Principal Investigator: ____________________
Sequencing Core PI login:____________________
E-mail:______________@_________________
Lab Contact:____________________________
E-mail:______________@_________________
Phone:________________________________ ___
Service*
I.
Cost
Quantity
Subtotal
a.
b.
Full Service processing of Total RNA
Std: min. of 250ng and 50ng/ul
NuGen: min. of 10ng and 2ng/ul
$180.00
$212.00
_______
_______
_______
_______
a.
b.
c.
d.
e.
f.
g.
Affymetrix Arrays
Human Gene ST 2.1 Strip (4 arrays)
Human U219 Strip (4 arrays)
Human U133 Plus 2.0 (1 array)
Mouse Gene ST 2.1 Strip (4 arrays)
Mouse 430 2.0 Strip (4 array)
Other: _______________________
User Supplied:_________________
$500.00
$320.00
$250.00
$500.00
$1000.00
$
N/A
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
_______
II.
Total
_______
*Please complete both sections as best as possible.
More arrays are available than listed above; please consult the Affymetrix website (http://www.affymetrix.com)
and/or the Microarray Core website (http://www.umich.edu/~caparray/gene_expression/).
By signing below I agree to the following terms:
1.
2.
3.
Agree that the items and services request above will be recharged upon completion of project.
Any rebilled arrays and reagents have a 6-month shelf-life from time of receipt at the Core.
The core is not responsible for projects not completed within 6 months of initial request.
Project Name:______________________________________________________________________
Billing Department____________________________________ UM Short Code:|__|__|__|__|__|__|
Print Principal Investigator Name: ______________________________________________________
Principal Investigator Signature:_____________________________ Date:______________________
2/12/2016
University of Michigan
MicroArray Core
Total RNA Sample Submission Form*
P.I. Name & Sample #
Concentration
(NanoDrop/UV)
Volume Submitted
(minimum of 10 uL)
Example: Krebs_001
125 ng/uL
10 uL
1.______________________
_____________________
____________________
2.______________________
_____________________
____________________
3.______________________
_____________________
____________________
4.______________________
_____________________
____________________
5.______________________
_____________________
____________________
6.______________________
_____________________
____________________
7.______________________
_____________________
____________________
8.______________________
_____________________
____________________
9.______________________
_____________________
____________________
10._____________________
_____________________
____________________
11._____________________
_____________________
____________________
12._____________________
_____________________
____________________
*Please see our website for sample naming convention (http://www.umich.edu/~caparray/sample_policy/). When the project
is completed, please contact us to arrange sample collection.
Data Analysis:
Please provide or attach a description of the experimental data analysis you would like performed when the arrays
are completed.
Example: Samples 1-3 (Control untreated), 4-6 (PC3 untreated), 7-9 (Control drug treated 3hr), and 10-12 (PC3 drug treated
3hr) are biological replicates. I am interested in comparing the gene expression of the control vs PC3 cells, the treated vs
untreated, and the interaction between cell type and treatment status.
2/12/2016