If your Study or Collaboration was approved please submit this form to request sample label.

Your Name:*

Your Email:*

Phone Number:*


Billing Info

Billing Code:*

Primary Investigator:*

Primary Study:*


Request Info

Laboratory Contact:*

Process Request:*

Note: Included in Data Request are:

  1. # OF ALIQUOTS
  2. QUANTITATION
  3. QUALITATION
  4. DERIVATION

If you need additional information please enter it in the comments box at the end.



Note: Please send manifest containing the information below for each aliquot to be stored:


  1. HIHG ID/Aliquot Name/Sample Number
  2. SAF ID
  3. Local ID
  4. Matrix Type
  5. Plate Number
  6. Position (1, 2, 3…)
  7. Volume

Additional information can exists but is not required.


Qty of Sample Requested:*

Units:*

Sample Type:*

Tissue Type:*

Sample Numbers:*   

Total Samples:*


For DNA Aliquots Only

Quantitation Method:*

Final Concentration: (ug/ul)*

Minimum EQ Score:*

Type of Tube:*

Diluent:*

Comments:   (300 char max)

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If you have any questions please contact Bio-Repository
Phone: 305-243-3822
Email: hihgbank@med.miami.edu