Proteomics Mass Spectrometry Facility FormContact InformationName(Required) First Last Phone(Required)Email(Required) Principal Investigator(Required)Institution(Required)Type(Required) UCI-based investigator Non-Profit CorporateBilling #PO # Sample SubmissionType of Analysis(Required)– Select –Total Proteome AnalysisTotal Proteome with Mini-phosphoQuant-IPPhospho analysis (pST)Phosphotyrosine analysis (pY)Single MS RunNumber of Sample Sets(Required)– Select –0102030405060708091011121314151617181920(How many “plexes” are you submitting?) Each set of samples (“plex”) will be assigned a letter. Each sample within a plex will be assigned a number. Please add the sample information next to the corresponding alphanumeric code suggested below. For example, if samples for a 6- to 16-plex are submitted together, your tubes may be labeled A1-A6 and B1-B16.Plex – ASpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…A1A2A3A4A5A6A7A8A9A10A11A12A13A14A15A16A17A18Plex – BSpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…B1B2B3B4B5B6B7B8B9B10B11B12B13B14B15B16B17B18Plex – CSpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…C1C2C3C4C5C6C7C8C9C10C11C12C13C14C15C16C17C18Plex – DSpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…D1D2D3D4D5D6D7D8D9D10D11D12D13D14D15D16D17D18Plex – ESpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…E1E2E3E4E5E6E7E8E9E10E11E12E13E14E15E16E17E18Plex – FSpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…F1F2F3F4F5F6F7F8F9F10F11F12F13F14F15F16F17F18Plex – GSpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…G1G2G3G4G5G6G7G8G9G10G11G12G13G14G15G16G17G18Plex – HSpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…H1H2H3H4H5H6H7H8H9H10H11H12H13H14H15H16H17H18Plex – ISpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…I1I2I3I4I5I6I7I8I9I10I11I12I13I14I15I16I17I18Plex – JSpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…J1J2J3J4J5J6J7J8J9J10J11J12J13J14J15J16J17J18Plex – KSpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…K1K2K3K4K5K6K7K8K9K10K11K12K13K14K15K16K17K18Plex – LSpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…L1L2L3L4L5L6L7L8L9L10L11L12L13L14L15L16L17L18Plex – MSpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…M1M2M3M4M5M6M7M8M9M10M11M12M13M14M15M16M17M18Plex – NSpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…N1N2N3N4N5N6N7N8N9N10N11N12N13N14N15N16N17N18Plex – OSpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…O1O2O3O4O5O6O7O8O9O10O11O12O13O14O15O16O17O18Plex – PSpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…P1P2P3P4P5P6P7P8P9P10P11P12P13P14P15P16P17P18Plex – QSpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…Q1Q2Q3Q4Q5Q6Q7Q8Q9Q10Q11Q12Q13Q14Q15Q16Q17Q18Plex – RSpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…R1R2R3R4R5R6R7R8R9R10R11R12R13R14R15R16R17R18Plex – SSpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…S1S2S3S4S5S6S7S8S9S10S11S12S13S14S15S16S17S18Plex – TSpecies(Required)– Select –humanmousedrosophilaC. elegansS. cerevisiaeXenopusZebrafishOther(all samples must be from the same species)Please describe(Required)Enter other…T1T2T3T4T5T6T7T8T9T10T11T12T13T14T15T16T17T18Are there any exogenous protein sequences expressed in your samples? if yes please elaborate in notes with taxonomy and/or specific (recombinant) protein sequences and their names. 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