ILLUMINA SUBMISSION FORM

Submission No. ______________
DATE:______________
ILLUMINA SUBMISSION FORM
*PLEASE ENSURE BOTH SIDES OF FORM ARE FILLED OUT ENTIRELY*
Sample submitted by: ________________________
PI: ________________________________________
Telephone: _________________________________
Email Address: ______________________________
PI Email Address: ______________________________
Signature: _________________________________
Institution/Company Name: ____________________
Bill To/Accounts Payable: ______________________
__________________________________________
__________________________________________
Account/P.O. No.: ____________________________
Funding Source: ☐NIH ☐NSF ☐GLBRC
☐USDA ☐Other
UW Affiliation: ☐UWCCC
☐Waisman Ctr.
UW Institution: ☐SMPH☐CALS ☐L&S ☐SOP
☐UW System ☐External
☐COE ☐Other ___________________
___________________________________________________________________________________________
Name of Organism: __________________________________________________________________________________
Input Nucleic Acid: ☐gDNA
☐cDNA
☐ChIP (shearing size_____________)
☐total RNA
☐mRNA
☐ribo-Reduced RNA
☐smallRNA
☐Other (provide explanation of content) _____________________________________________________________
Library Type:
DNA:
☐gDNA ☐gDNA low input ☐ChIP ☐exome ☐Genotyping by Sequencing(GBS)
RNA:
☐mRNA
☐ribo-reduced RNA ☐stranded mRNA ☐stranded ribo-reduced RNA ☐smallRNA
Amplicon: ☐16s (v3-v4) ☐ITS (ITS1-2) ☐18s ☐index only ☐custom amplicon___________
☐Other (discuss with facility before submitting)________________________________________________________
☐QC only (Library prepared by lab)___________________________________________________________________
Kit Used to make libraries__________________________________________________________________
Sample Buffer: _______________
Indexing:
# samples per lane: ___________________
Sample Information:
• Please fill out the following table with appropriate information.
• Submit samples in 1.5mL single tubes or a 96 well plate.
• All sample tube/plates must be labeled with the sample name, PI last name, and date.
• If submitting >8 samples, please attach an excel list of all samples to this form and email all sample
information to [email protected]
Sample 1
Sample 2
Sample 3
Sample 4
Sample 5
Sample 6
Sample 7
Sample 8
Sample Name
FOR OFFICE USE ONLY:
☐GS ☐Protocol ☐Run #_____
Conc. (ng/μl)
A260/A280
☐Run Date _____/_____/_____
Volume (μl)
Total (μg)
☐Bill Date _____/_____/_____
Index
☐ASANA
Attach gel image here, or send via email to [email protected]:
___________________________________________________________________________________________
Sequencing options:
☐HiSeq HighOutput
☐1x50
☐2x50
☐1x100
☐2x125
☐Full Flowcell
☐HiSeq Rapid Run
☐1x50
☐2x50
☐1x100
☐2x100
☐2x150
☐2x250
☐Full Flowcell*
☐MiSeq
☐1x50
☐2x75
☐2x150
☐2x250
☐2x300
☐Nano
Custom Primer (name): ___________________________________
*HiSeq Rapid flowcells must have the same library (or pool) loaded into both lanes
___________________________________________________________________________________________
Bioinformatics options:
☐UWBC Bioinformatics Resource Center (email [email protected] at sample submission)
☐Collaborator: Name_________________________________ Email________________________________
☐By Submitting Lab
I have read and understand the Illumina Sequencing Policy found on the UWBC website (please
initial):_________

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