Australian BioResources REQUEST TO IMPORT MICE

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Australian BioResources
REQUEST TO IMPORT MICE
All fields in this form must be completed, indicate N/A if not applicable
Please email this form to [email protected]
1. PERSONAL INFORMATION
Date of Request
Owner
Principal Investigator
Contact Name
Email Address
Phone Number
AEC Approval #
IBC Approval #
Will this line be created at ABR?
Yes
No
2. SUPPLIERS INFORMATION
Name of Facility
Contact Name
Email Address
Phone Number
Is a Material Transfer Agreement
required for this strain? If yes, please
provide a copy.
Yes – Please provide a copy
No
3. STRAIN INFORMATION
Strain Name
Stock Number (if applicable)
Number of Mice
Sex
Genotype of mice required
Do you want this line publically
viewable?
Yes - this information will be sent to the Australian
Phenomics Database and made public
No
Signature
Effective 1/2/15
1
Australian BioResources
LINE INFORMATION FORM
Complete one form for each new line
1. LINE INFORMATION
ABR short line name (suggestion)
Long line name (please use standard
international nomenclature)
Is this is a cross of lines already at
ABR?
Yes
No
Names of lines to be crossed (if
applicable)
2. GENOTYPE INFORMATION & INSTRUCTIONS
Gene Name (Max 6 characters)
Gene Type (eg tg.KO)
List of possible genotype results
Briefly describe how the line was
made and the expected function of the
gene combination
Current background strain of line
Generation Number (if applicable) of
mice to be imported
Genotyping Instructions
Please select ONE option – further
information is available at
http://www.abr.org.au/services/mousegenotyping
I wish to use the Mouse Genotyping Service & have
genotyping automatically performed for me.
(NB you will need to establish the genotyping conditions, please
refer to http://tinyurl.com/lgtmct5)
I will do my own genotyping.
(TAIL tissue will be sent to your facility, unless a different tissue
type, and/or different destination facility is specified)
Comments:
Effective 1/2/15
2
Australian BioResources
3. PHENOTYPE INFORMATION
Describe the phenotype of the line.
Include special monitoring or care
requirements
Can mice mount a serology response
for health screening? (Can these mice
be considered immunocompetent)
Yes
No
MGI no:
Journal reference
4. BREEDING
Initial Breeding Instructions
Signature
Effective 1/2/15
3
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