***Online submittal feature is currently unavailable. Please print out this form and fax to (858) 784-2754 or deliver to DNA Array Core Facility when submitting samples. Thank you for your patience and understanding as we work to fix this error.***

DNA ARRAY CORE FACILITY

AFFYMETRIX SAMPLE SUBMITTAL FORM - Please note that all fields are REQUIRED!!!

GENERAL INFORMATION:

Date:

PI:

last name first name

Contact Person:

last name first name

Department: Telephone Number: Email:

If project is supported by one of the following program grants, please check the appropriate one:
  Scripps NeuroAIDS Preclinical Studies (SNAPS)
  National Eye Institute - Core Center for Vision Research at TSRI (NEI)

 

SAMPLE INFORMATION:

Type of Experiment: Normal vs. Diseased Tissue Comparison
  Time Course
  Effects of Gene Knockout
  Other:

How many samples do you have?

*** Please note: Sample names must be unique and descriptive! Please do not label your samples 1, 2, 3, 4, etc.! ***

Sample #
Sample Name
Conc. (ug/ul)
Amt. (ug)
GeneChip
Species
Tissue/Cell Line
Sample Strain
Sample Sex
Sample Age
Disease State
Genetic Manipulation

Comments/Brief Experiment Description:

Before submitting your sample information, you must agree to the following terms:

I have read and agree to the above terms