Multi-sample Submit

Proteomics Center

Sample Submission for Analyses

Please complete this form and submit it before presenting samples to the Proteomics Core Labs.

SAMPLES WILL NOT BE PROCESSED UNTIL A COMPLETED ELECTRONIC VERSION OF THIS FORM IS RECEIVED.

Part A: Investigator / Submitter Information

Contact Information:

Submitter Name: Submitter Phone:

FAX: Submitter e-mail:

Principal Investigator: Prin. Invest. e-mail:

Department Name: Department Number:

Division Name: Campus Box:

Is this work being performed for a grant submission?

Yes No

If so, deadline for grant submission data:

-- mm/dd/yy

Part B: Experimental Information/Design

Experiment Name: Experiment names may be 14 characters long and may include letters, numbers, and the underscore character. Avoid other non-alphanumeric characters and generic names like 'control', 'WT', or 'normal'.

Description of Experiment: Describe the aim of the experiment.

Experiment Name (may be up to 14 characters):

Provide a brief description of this experiment (100 words or less):

Part C: Sample Descriptions for Multi-Gel Analysis

Sample Name: Sample names may be 8 characters long and may include letters, numbers, and the underscore character. Avoid other non-alphanumeric characters and generic names line 'control', 'WT', 'normal'.
Sample Type: Choose whether the sample source could be considered 'Tumor', 'Normal', 'Diseased', or 'Transgenic' (includes all genetically manipulated samples, e.g. KO mice).
Sample Description: Please provide a detailed description of non-protein sample contents. Include concentrations of salts and detergents in the samples. Unreported non-protein components may make it impossible to correctly process your samples. Please be complete.
Estimated Amount of Protein: In order for the DIGE experiment to generate protein spots containing sufficient protein to allow identification by tandem mass spec, at least 5 mg of protein is required (25-200 mg recommended) for each sample to be analyzed. Please contact us at (314) 286-2452 for all samples falling outside of this range.

Sample 1 Information

Sample Name:

Sample Species:

Sample Type:

Sample 1 Description:

Estimated Amount of Protein (25 mg at 4-10 mg/ml recommended)

Sample 2 Information:

Sample Name:

Sample Species:

Sample Type:

Sample 2 Description:

Estimated Amount of Protein (25 mg at 4-10 mg/ml recommended)

Sample 3 Information:

Sample Name:

Sample Species:

Sample Type:

Sample 3 Description:

Estimated Amount of Protein (25 mg at 4-10 mg/ml recommended)

Sample 4 Information:

Sample Name:

Sample Species:

Sample Type:

Sample 4 Description:

Estimated Amount of Protein (25 mg at 4-10 mg/ml recommended)

Sample 5 Information:

Sample Name:

Sample Species:

Sample Type:

Sample 5 Description:

Estimated Amount of Protein (25 mg at 4-10 mg/ml recommended)

Sample 6 Information:

Sample Name:

Sample Species:

Sample Type:

Sample 6 Description:

Estimated Amount of Protein (25 mg at 4-10 mg/ml recommended)

Sample 7 Information:

Sample Name:

Sample Species:

Sample Type:

Sample 7 Description:

Estimated Amount of Protein (25 mg at 4-10 mg/ml recommended)

Sample 8 Information:

Sample Name:

Sample Species:

Sample Type:

Sample 8 Description:

Estimated Amount of Protein (25 mg at 4-10 mg/ml recommended)

Sample 9 Information:

Sample Name:

Sample Species:

Sample Type:

Sample 9 Description:

Estimated Amount of Protein (25 mg at 4-10 mg/ml recommended)

Sample 10 Information:

Sample Name:

Sample Species:

Sample Type:

Sample 10 Description:

Estimated Amount of Protein (25 mg at 4-10 mg/ml recommended)

Once you submit this data by clicking the "Submit Form" button below, you will receive an experiment number. Please include this number on each of the sample containers you submit to the core.

Submitter Name:		Submitter Phone:
FAX:		Submitter e-mail:
Principal Investigator:		Prin. Invest. e-mail:
Department Name:		Department Number:
Division Name:		Campus Box: