MiSeq Sample Submission Form

Required fields are marked with an asterisk (*).

Customer Information

First Name*
Last Name*
Institution*
Department*
Supervisor*
Address*
Phone*
Email*
Date of Sample Submission*	12345678910111213141516171819202122232425262728293031 JanFebMarAprMayJunJulAugSepOctNovDec 2018201920202021202220232024202520262027202820292030203120322033203420352036203720382039204020412042204320442045204620472048204920502051205220532054205520562057205820592060206120622063206420652066206720682069207020712072207320742075207620772078207920802081208220832084208520862087208820892090209120922093209420952096209720982099
Are samples to be returned after project completion?*	NoYes
I will acknowledge the WSU NGS facility in any publication or presentation where this data is used*	YesNo

Project Description

Name Your initials and amplicon e.g. KA_16S_Sequencing
Number of samples
Sequencing project and quote number
Service requested*	Bacterial 16S 341F/805R Bacterial 16S 515F/806R Bacterial 16S 27F/519R Bacterial 16S 799F/1193R Fungal ITS2 fITS7/ITS4 Fungal ITS1 ITS1f/ITS2 Fungal ITS1&2 ITS1oo/ITS4 Fungal AMF SSU rRNA (WANDA/AML2) Fungal 28S rRNA (1274f/706r) Protist 18S Euk_1931f/EukBr Custom primers Other*
*If other, please specify
What is the dollar value (AUD) of the samples being submitted?* For insurance reasons, please, provide sample valuation according to this document for valuation of samples

Sample Description

Sample Type*	gDNACustom Amplicons
Samples extracted from* (e.g. soil, animal tissue, plant, leaf, fungi, etc)
Sample taxa*
Extraction method*
My samples contain >50% host DNA	YesNo
If “yes” what host DNA contamination do you expect? (species, mtDNA/gDNA, percentage)
Samples were eluted in water (PLEASE NOTE: No other elution buffer will be accepted. Samples in elution buffer other than water will be rejected.)	-- Please Select --YesNo
Concentration measured by*	NanodropQubitPicogreen
Concentration of all DNA samples ≥ 20 ng/ul * A charge will be applied to all samples <20ng/uL	YesNo
Additional comments or special notes?
Please download and complete MiSeq Sample Submission Sheet (.xls or .xlsx)* See MiSeq guide for examples. Please note: file type must be .xls or xlsx and below 10mb.
Gel documentation for metagenomics* Image must be of pdf, png or jpg file type and below 20mb