Form to request strain background check

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PI Date
Contact person Lab room
Phone Email
Department Cancer Center member?
PTAO Funding source NIH etc.
Donor strain
Zygosity
Strain name Modified gene
Lab prepares tail DNA?
(fill the line below)
Backcross generation  
DNA  volume DNA concentration
Sample designation:
1 6    11   16
2 7    12 17
3 8    13 18
4 9    14 19
5 10    15 20
Recipient strain
Zygosity
Strain name

 

If from vendors, fill the line below.

Vendor Stock #
Animal protocol # CCM #
Mouse room:

Brief description of the project and special note to GTTF:

If the request lab prepares DNA, it is important to make a clean prep of the mouse tail DNA.  We request at least 100 ul (100 ng/ul) to be submitted.  Upon a testing PCR run, we'll let you know if re-prep is necessary.  Otherwise, we'll proceed with the full panel PCR.

investigator's signature for agreeing to 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.