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Internal Request for Mass Spectromic Analysis Wichita State University, Department of Chemistry Email: [email protected], [email protected] Incomplete forms will cause samples to be rejected. Max turnaround time: 2 weeks. Write legibly. If your sample has special requirements (keep frozen until analysis, sensitive to acid, etc) please describe in Extra Notes. Samples can be submitted directly to room 318 or placed on the labeled counter top in 319. Sample ID: Date Submitted: Name: Advisor: Email Address: Sample is Soluble in: H2O MeOH Concentration or weight of Sample: CH3CN Isopropanol Other Solvent (if in solution): _____________________ Method of Purification: ____________________________________________ Desired Analysis (check all that apply): Agilent 6230 ToF Positive mode (detects positive ions) High Resolution MS Negative mode (detects negative ions) High Resolution MS Molecular Formula: ___________________________________ Target Mass (or molar mass): _________________________________________ Structure: Extra Notes: _________________________________________________________________________