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