Neuroarray Nomination Form

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The Science of Drug Abuse and Addiction from the National Institute on Drug Abuse

Neuroarray Individual Submission form

If you wish to make multiple submissions, please use the
Neuroarray Nomination Sheet for Batch Submissions--Human Data Only (Excel format) and
e-mail to NIDA_neuroarray@nida.nih.gov

Submitter Name *:
Submitter E-mail:

Gene or Allele Symbol/Name: (example of gene-CHRNA4; example of allele-CYP2C92)*
Nickname/synonyms for this gene or allele: (example: BFNC)
Chromosome (example: 20)
Location (example: 20q13.2-q13.3)

Fill in as many of the unique identifiers for your gene or allele below

dbSNP rs_number (example: rs16969968)
Is the SNP in HapMap I or II?	Yes No Don't Know

GenBank
Entrez Gene GeneID (example: 1137) MIM (example: 118504)
EnSEMBL gene_id
PubMed (example: 11450844)
NM_identifier (example: NM_000744)

Tell us how many flanking kb should be screened for SNPs if no SNPs are
provided for submission of a gene. Or, if you have a private SNP, please
provide 100 bp of flanking sequence in the text box.

Bases_upstream
Bases_downstream

Genomically 5' position (example: 61445109)
Genomically 3' position (example: 61463192)

* Please note that the 5' position of the genomic region cannot be
larger than the 3' position of the genomic region

Please provide MAFs in each population, if known. (Priority wil be given to
SNPs in multiple populations, please add further information in the
comment field if you have it)

YRI
JPT
CHB
CEU
Comment:

How would you categorize your SNP in relation to a disease or pathway,
please select all that apply

Addiction related
Psychiatric disease related
Structural variation related
Pharmacogenetic related
Epigenetic related
Cell adhesion related
Signal transduction related
Neurotransmission related
Gene regulation related
Other, please explain

Is gene or allele in a linkage peak from linkage analysis, or from a QTL analysis? If yes, please include details of the analysis in the justification comments section.

Yes
No

Justification Comments:

The National Institute on Drug Abuse (NIDA) is part of the National Institutes of Health (NIH) , a component of the U.S. Department of Health and Human Services. Questions? See our Contact Information. Last updated on Tuesday, October 9, 2007.