F011.01
Record of Rodent Exportation
Other Institution’s Information
Cornell Information
Institution:
Cornell University
Institution:
Investigator:
Investigator:
Department:
Department:
Lab Contact:
Lab Contact:
Phone:
Phone:
Fax:
Fax:
Email:
Email:
Veterinarian:
Erin Daugherity
Veterinarian:
Phone:
(607) 253-4118
Phone:
Fax:
(607) 253-3527
Fax:
Email:
Shipping
Contact:
Phone:
Fax:
Email:
Email:
Ekr2@cornell.edu
Shipping
Contact:
Scott Soprano/Emily Silvela
Phone:
(607)220-3663/(607) 743-9510
Fax:
(607) 253-3527
Email:
sms454@cornell.edu
/ejb48@cornell.edu
Animal Information
Species:
Mouse
Number Shipping:
#M/#F:
Background Strain:
Age:
Facility:
Room Numbers:
Animal Health:
Are these animals immunodeficient?
Animal Health information is available at:
http://ras.research.cornell.edu/care/health.html
Yes
No
Unknown
Approval by the Other Institution:
Approved IACUC Protocol Number:
Send copy of approval letter by e-mail or fax to Scott Soprano/Emily Silvela (Contact info above)
Exportation is:
Shipping Address
Shipment is paid/arranged by:
Courier Information:
Notes:
Accepted
Rejected By/Date:
F011.01