***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:

1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2004 2005

PI:

last name first name

Contact Person:

last name first name

Department: Cell Biology Chemistry Immunology ICND Molecular Biology Molecular & Experimental Medicine Neurobiology Neuropharmacology Skaggs non-TSRI Telephone Number: Email:

SAMPLE INFORMATION:

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.! ***

Comments/Brief Experiment Description:

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

• GeneChip data is available approximately 2 weeks after RNA samples and GeneChips are submitted to the lab. You will be notified if turnaround time is longer than the allotted 2 weeks. When sample processing is complete and data is available, you will be contacted by the Core Facility to pick up your data (in CD format) from the lab.
• The DNA Microarray Core Facility will store any leftover total RNA, cRNA and hybridization cocktail at -80°C for up to one month. Samples may be stored longer than the allotted month AT YOUR OWN RISK. We are NOT responsible for materials left in our possession for more than one month! If you would like to reuse your material in the future, please be sure to collect your total RNA, cRNA and hybridization cocktail when you pick up your data.