Sample Submission

 

Submitter
Name:
  Phone: Email:
PI Name: Department: UMMS
Speed Type:

Billing Address (If not UMMS user):
Address line 2:   
City, State, Zip           

Purpose (Please provide a brief description of the goal of the project):

 

Sample Information (gel-staining buffer, in solution-buffer, species):

  

 

Gel staining (Coomassie, silver, etc)
Protein concentration or total amount 
 Sample is: Specify Buffer
 
 
 
 
Expected MW Range 
 
 
 
  
 
 
Small Molecules 
 
 
 
 
 
 
 
 
  Specify Buffer
  
Biosafety (must be completed)
Is recombinant DNA found in the sample?  Yes  No

Is sample derived from an infectious agent? Yes No   

If Yes, what is the risk group? RG1 RG2RG3

What is the biocontainment level? BSL-1 BSL-2BSL-3

 

see ABSA: http://www.absa.org/riskgroups/index.html

see BMBL5:  http://www.cdc.gov/biosafety/publications/bmbl5/index.htm

If any of the answers above are "Yes",
does submitting PI have IBC approval? Yes No

If Yes, provide UMMS IBC Docket number: 
 

If outside UMMS, please email a copy of your institutional IBC approval letter to:  
proteomics@umassmed.edu

 

Sample List (sample ID must be as indicated on vial/tube):

 

Special Request:

 

 

Proteomics and Mass Spectromy Facility
UMass Medical School

Fuller Building
222 Maple Avenue
Shrewsbury, MA 01545
Inquiries

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