LRI Genomics Core Facility
http://www.lerner.ccf.org/services/gc/
NE5-253, Phone: 216-444-0974
LERNER RESEARCH INSTITUTE
Agilent Bio-analyzer Request Form
Date: ______________________________________
Submitted by: ______________________________
PI Name: ___________________________________
CCF Email: ___________________________@ccf.org
PI Email: ___________________________________
Non-CCF Email: _____________________________
Phone number: _____________________________
Non-CCF Affiliation: _________________________
Department: _______________________________
Phone number: _____________________________
Activity or PO#: _________________________
Sample type: _____ mRNA, _____ smallRNA, _____ High conc. DNA, ____ Low conc. DNA
Agilent chip type: _____ HS DNA, _____ RNA Nano, _____ RNA Pico, _____ Small RNA
Note: At least 3 µl of each sample is required for submission.
Please list your samples below (use additional sheets if needed):
Sample #
Sample name
Sample conc. (ng/ul)
Comments
Core Use Only
1
2
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9
10
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I, ______________________________ (PI’s name) declare that the samples submitted to the Core do not
contain an agents (biological or otherwise that can be harmful to those processing the samples
Name: _____________________________
Date: __________________________
Any related questions can be directed to: LRIgenomics@ccf.org
Date completed:
FOR CORE
USE ONLY
Performed by:
Charges: