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 e.isedale@garvan.org.au
1. PERSONAL INFORMATION
Date of Request
Owner
Principal Investigator
Contact Name
Email Address
Phone Number
AEC Approval #
IBC Approval #
Will this line be made at ABR? Y/N
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.
3. STRAIN INFORMATION
Strain Name
Stock Number (if applicable)
Number of Mice
Sex
Genotype of mice required
Do you want this line publically
viewable? If Yes, this information will be
sent to the Australian Phenomics
Database
Signature
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? Y/N
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
Background strain of line
Generation Number
I wish to use the Mouse Genotyping Service & have
genotyping automatically performed for me.
Genotyping Instructions
Please select one option – further
information is available at ###link to
service page###
I will do my own genotyping, send the following to me (delete
as appropriate):
Ear tissue
Tail tissue
Blood
Comments:
3. PHENOTYPE INFORMATION
Describe the phenotype of the line.
Include special monitoring or care
requirements
2
Australian BioResources
Can mice mount a serology response
for health screening? (Can these mice
be considered immunocompetent)
Y/N
MGI no:
Journal reference
4. BREEDING
Initial Breeding Instructions
Signature
3