Biorepository – Sample Request "*" indicates required fields Name* First Last Position* Institution* Shipping Address*Address where samples would be sent Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Address* Enter Email Confirm Email Project Title* Project Description (2-3 sentence description)*At your request, the project overview may be posted on the COMBINEDBrain websiteSample Request*Bosch-Boonstra-Schaaf Optic Atrophy Syndrome (NR2F1)CACNA1A mutation (CACNA1A)CACNA1H mutation (CACNA1H)CHAMP1 mutation (CHAMP1)CHD2-Related Neurodevelopmental Disorder (CHD2)Chromosome 8p Disorders (8p)DYRK1A mutation (DYRK1A)FOXG1 mutation (FOXG1)Glut1 Deficiency Syndrome (SLC2A1)GRIN-Related Disorders (GRIN)Hao-Fountain Syndrome (USP7)Helsmoortel-Van Der Aa syndrome (ADNP)HNRNPH2 mutation (HNRNPH2)Hunter Syndrome (MPSII, IDS)KIF1A Associated Neurological -Disorder (KIFA1)KCNQ2 Encephalopathy (KCNQ2)Kleefstra syndrome (EHMT1)Malan Syndrome (NFIX)Phelan-McDermid Syndrome (SHANK3)SATB2-Associated Syndrome (SATB2)Schinzel-Giedion Syndrome (SETBP1)SCN2A mutation (SCN2A)SCN8A mutation (SCN8A)SETBP1 Deficiency Disorder (SETBP1)SHANK2 mutation (SHANK2)SLC6A1 mutation (SLC6A1)STXBP1 Disorders (STXBP1)SynGAP1-Related Intellectual Disability (SYNGAP1)Zellweger Spectrum Disorder (PEX)Normal ControlOtherPlease Specify Other Sample Request* Other Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsOther Aliquots/Vials*Select12345BBSOAS Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsBBSOAS Aliquots/Vials*Select12345CACNA1A mutation Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsCACNA1A mutation Aliquots/Vials*Select12345CACNA1H mutation Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsCACNA1H mutation Aliquots/Vials*Select12345CHAMP1 mutation Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsCHAMP1 mutation Aliquots/Vials*Select12345CHD2-Related Neurodevelopmental Disorder Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsCHD2-Related Neurodevelopmental Disorder Aliquots/Vials*Select12345Chromosome 8p Disorders Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsChromosome 8p Disorders Aliquots/Vials*Select12345DYRK1A mutation Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsDYRK1A mutation Aliquots/Vials*Select12345FOXG1 mutation Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsFOXG1 mutation Aliquots/Vials*Select12345Glut1 Deficiency Syndrome Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsGlut1 Deficiency Syndrome Aliquots/Vials*Select12345GRIN-Related Disorders Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsGRIN-Related Disorders Aliquots/Vials*Select12345Hao-Fountain Syndrome Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsHao-Fountain Syndrome Aliquots/Vials*Select12345Helsmoortel-Van Der Aa syndrome Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsHelsmoortel-Van Der Aa syndrome Aliquots/Vials*Select12345HNRNPH2 mutation Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsHNRNPH2 mutation Aliquots/Vials*Select12345Hunter Syndrome Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsHunter Syndrome Aliquots/Vials*Select12345KIF1A Associated Neurological -Disorder Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsKIF1A Associated Neurological -Disorder Aliquots/Vials*Select12345KCNQ2 Encephalopathy Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsKCNQ2 Encephalopathy Aliquots/Vials*Select12345Kleefstra syndrome Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsKleefstra syndrome Aliquots/Vials*Select12345Malan Syndrome Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsMalan Syndrome Aliquots/Vials*Select12345Phelan-McDermid Syndrome Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsPhelan-McDermid Syndrome Aliquots/Vials*Select12345SATB2-Associated Syndrome Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsSATB2-Associated Syndrome Aliquots/Vials*Select12345Schinzel-Giedion Syndrome Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsSchinzel-Giedion Syndrome Aliquots/Vials*Select12345SCN2A mutation Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsSCN2A mutation Aliquots/Vials*Select12345SCN8A mutation Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsSCN8A mutation Aliquots/Vials*Select12345SETBP1 Deficiency Disorder Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsSETBP1 Deficiency Disorder Aliquots/Vials*Select12345SHANK2 mutation Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsSHANK2 mutation Aliquots/Vials*Select12345SLC6A1 mutation Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsSLC6A1 mutation Aliquots/Vials*Select12345STXBP1 Disorders Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsSTXBP1 Disorders Aliquots/Vials*Select12345Zellweger Spectrum Disorder Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsZellweger Spectrum Disorder Aliquots/Vials*Select12345SynGAP1-Related Intellectual Disability Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsSynGAP1-Related Intellectual Disability Aliquots/Vials*Select12345Normal Control Sample Type*Select Sample TypePlasmaSerumBuffy CoatUrinePeripheral Blood Mononuclear CellsFibroblastsLymphoblast Cell LinesInduced Pluripotent Stem CellsNormal Control Aliquots/Vials*Select12345NameThis field is for validation purposes and should be left unchanged. Δ