Protein Chip-SELDI MS Please print out and fill in the form below, and return to Hyuk-Kyu Seoh Rm: NSC 516 Tel: (404) 413-5379 Additional Services available (consult with Core Facility for Information and Form): Biomarker Discovery and Validation Expression Difference Mapping Protein Purification Protocol Development Protein ID (peptide Mapping) Standard Buffers Basic Service (See Form Below) Full Service Request Form

Ciphergen Basic Service Request Form
Biotechnology & Drug Design Core Facility, Georgia State University			Contact: Hyuk-Kyu Seoh Natural Science Center, 50 Decatur St, Atlanta, GA 30303
Additional Information:	Use separate forms for each experiment (use of different chip reading protocols)
	Bring USB mini drive with chip
Contact Name:
Contact Phone:		E-mail:
Department/University:
Address:
P I's Name:		Acct / PO #
P I's Signature:
Sample Information	Estimated MW of Target Protein (if known) ___________________
	Target Range of Molecular Mass: Low Mass   ___________
	Target Range of Molecular Mass: High Mass   ___________
	EAM Solution Saturation (CHCA, SPA, EAM-1) _________(%)
	EAM Application ____________ul X ____________
	Sample Origin ____________________________
Is Sample a Biohazard?	(Y/N) ________________
	If Yes, please explain:  _________________________________
	Any additional Sample Information: ____________________
	________________________________
	________________________________
Chip Information	Chip ID #
	1. ________________________________
	2. ________________________________
	3. ________________________________
	4. ________________________________
	5. ________________________________
	6. ________________________________
	7. ________________________________
	8. ________________________________
	9. ________________________________
	10. ________________________________
	Total # of Chips; all Experiments ____________________
Molecular Standard Calibration	(Y/N)  ___________________________
	# Separate calibration/protocol  _____________________
Data Analysis/Consultation	(Y/N)  ________________________________

Full Service Includes: Initial consultation on Project feasibility and direction Facility provides chip and sample application in Standard conditions Chip reading (set of 2 readings for Low and High Mass Range) Report (Mass list and/or spectrum)

	Charges :
		Chemical Surface. Normal phase. Whole chip: $120.00
		Chemical Surface. Ion-Exchange phase. Whole chip: $120.00
		Chemical Surface. Reverse phase. whole chip: $120.00
		Chemical Surface. Reactive surface. Whole chip: $150.00
		Biochemical Surface. Antibody-Chip. Whole chip: $230.00
	Calibration :	Molecular Standard Calibration: $50.00/experiment
	Data Analysis :	Analysis/consultation: $50/hour

Ciphergen Full Service Request Form
Biotechnology & Drug Design Core Facility, Georgia State University			Contact: Hyuk-Kyu Seoh Natural Science Center, 50 Decatur St, Atlanta, GA 30303
Additional Information:	Use separate forms for each experiment (use of different chip reading protocols)
	Bring USB mini drive with chip
Contact Name:
Contact Phone:		E-mail:
Department/University:
Address:
P I's Name:		Acct / PO #
P I's Signature:
Sample ID:	use Excel sample sheet; send to Kyu Estimated concentration (include on Excel sheet)
Sample Information	Origin (organism)  _______________________________
	Fractions of Sample   _____________________________
	Estimated MW of target protein (if Known)____________
Target Range of Molecular Mass for Mass Accuracy (area of interest)
	Low Mass Range ____________________________
	High Mass Range ____________________________
	Is Sample a Biohazard (Y/N) ________________
	If Yes, please explain:  _________________________________
	Sample Buffer: ____________________
	Additional Sample Information: _________________________
	________________________________
	________________________________
	________________________________
	1. ________________________________
	2. ________________________________
	3. ________________________________
	4. ________________________________
	5. ________________________________
	6. ________________________________
	7. ________________________________
	8. ________________________________
	9. ________________________________
	10. ________________________________

This information is given as a guide to the facilities and instrumentation available in the DNA/Protein Core facility at Georgia State University. If you have any concerns or thoughts about the content of this website please contact: John Houghton (404) 413-5390