Form to request ES cell injections into blastocysts

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PI Date
Contact person Lab room
Phone Email
Department Cancer Center Member?
PTAO Funding Source NIH etc.
Name of ES cell clone Targeted gene
ES cell line Euploidy ES cells
Lab prepares the ES cell?
Core prepares the ES cell?
Animal protocol# CCM#
Mouse room:

Brief description of the gene and aims of the targeting experiment:

We guarantee to inject at least 50 blastocysts, but don't guarantee that the ES cells will contribute to chimeras or pass through the germline, since this depends entirely on the pluripotency of the ES cells, which depends on the quality of the tissue culture during selection.  However, our track record has been very successful with high quality pluripotent ES cells.

investigator's signature for agreeing the terms

GTTF's signature for acceptance of the project

Please click "Submit" button to send the request electronically to GTTF.  Click "Back" button on your web browser to print, sign and bring the form to Jordan 2223 (ext. 2-3990) to confirm the timeline of the service.  Electronic signature is not available at this time.