Precision Medicine Research Sample Submission

PMRS Sample Submission Form

The Precision Medicine Research Service (PMRS) offers a variety of services for your sequencing needs such as, automated nucleic acid extractions, library preparation, and small scale sequencing projects. Please use this form for sample submissions.

REQUESTOR INFORMATION

Contact Person(Required)

First Last

Phone

Email(Required)

PI Name(Required)

First Last

PI Email(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Submission Date

Department Name

Fiscal Services Contact Name

First Last

Fiscal Services Contact Email

Funding Information

Program Code: Dept ID: Fund Code: Account: Project #:

IRB APPROVAL

Do you have IRB approval?

IRB APPROVAL

Yes

Not Applicable

UW or External #

SAMPLE INFORMATION

Service Requested:

DNA Extraction

RNA Extraction

Quality Control

Library Prep

Library Quality Control

Sequence

# of Samples:

Sample Notes:(Required)

Sample Information upload

Accepted file types: xlsx, xls, csv, Max. file size: 24 MB.

Comments

This field is for validation purposes and should be left unchanged.