REDERIVATION REQUEST FORM Date: Institution: Dept/Center: PI

REDERIVATION REQUEST FORM
Date:
Institution:
Dept/Center:
PI:
email:
Phone:
Account #:
Name and email address of contact person:
(TAMUS investigators only) IACUC Protocol #
(Please provide a copy of the approval letter with this request form)
(TAMUS investigators only) IBC Approval #
(Please provide a copy of the approval letter with this request form)
Project name (what your mice will be called):
Source (live mice, live embryos, frozen embryos, frozen sperm):
Strain background:
Number and age of males available:
Number and stage of embryos to be received:
Protocol used to cryopreserve sperm (Jax, other):
Desired strain background for oocyte donors:
Steps:
IACUC approval is required to import mice from another institution and transfer
rederived mice to the investigator on campus. TAMUS investigators first contact Ryan Byrd
([email protected], MS 4473, Fax 979-845-6706). CMP will coordinate with core staff.
Submit this form to Andrei Golovko ([email protected], fax: 979-458-5559)
The core will contact you to schedule the date for rederivation