TASQ Rederivation Request Form (Internal)
Rederivation ID (office use only):
Please fill out this form as completely as possible and return to Tracy Doan (fax or email a signed and scanned pdf
file). If not already provided to Importations Officer, please also attach a copy of the AEC Application, AEC Approval
Certificate and specific genotyping protocol.
If you have completed some of the requested information on the UQBR Importation form, please refer to that form.
Email: t.doan@uq.edu.au
Fax: (07) 3399 9999
Phone: (07) 3329 9999
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Contact Details
Chief Investigator:
Name:
Contact Phone:
Email Address:
Contact Researcher/Alternative Contact:
Name:
Email Address:
Fax:
Contact Phone:
After Hours Phone Contact:
Billing/Mailing Address:
Dept/Building/Street Address:
Receiving Institution Details (if applicable):
Facility Manager Name:
Email Address:
Delivery Address:
Contact Phone:
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Animal Ethics Approval Details (Please attach a copy of the AEC Application and Approval Certificate)
AEC Approval No.:
Expiry date:
Project Title:
IBC/OGTR No:
Dealing Type (eg DNIR, NLRD):
(Please note: Animals will not be rederived without prior ethics approval.)
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Rederivation Details
Species:
Name of strain:
Genotype of animals being rederived:
Homozygous Heterozygous Hemizygous Wild type
Type of Genetic Modification:
Transgenic
Knock out
Conditional (Flox, ER, Frt)
Knock in
Gene-trap
Knock down
Other…………………………............................................……
What background is the line?
C57BL6
CD1/ Outbred
B6CBF1 (hybrid)
129Sv
Other ..........……………
How many generations has this line been backcrossed? N…
What breeding protocol is required for this line?
Hom x Hom
Het x Het
Het x Wt
Other ............................................................................
Who is to perform the breeding of this line?
 Animal Facility Colony Manager
 Your lab
Are there any behavioural or physiological phenotypes in the line? Yes
If yes, please describe the phenotype (including time of onset).
Is this line embryo lethal? Yes
No
No
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Current Housing Details (if applicable)
Animal Facility where animals are currently held:
Room Number:
Staff member responsible for animals:
Name:
Email Address:
Contact Phone:
___________________________________________________________________________________
Animal Facility where animals are to be rederived into (indicate SPF or Conventional area)
Animal Facility Name:
Shipping Address (for use after successful rederivation):
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Screening requirements (if applicable):
All progeny from rederivation will be tissue sampled for genotyping.
This will ensure that all mice born from the rederivation are of the correct genotype required by the Client.
Samples to be:
 Collected at AIBN stores
 Shipped to client. Shipping Address for samples: ……….…………………………………………………….
……………………………………………………………………………………………….……………………………………………….
 Sent to genotyping service. Name and contact for genotyping company………………….………..……………
……………………………………………………………………………………………….……………………………………………….
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Rederivation Plan
For IVF rederivation we require 2 males and 8-10 females per round. The researcher will need to provide
information on how many animals are currently available. Please enter this information in the “Notes”
section below if you have this information now. If you plan to use wildtype females, they will be ordered
to coincide with the time that the rederivation is booked.
Male Genotype: …………………………………… Male Background: ……………………………………………..
Female Genotype: ……………………………….. Female Background: ………………………………………….
Notes: …………………………………………………………………………………………………………..……………………
Please attach an Abstract of the project.
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DECLARATION OF UNDERSTANDING AND COMPLIANCE
I, the undersigned, agree to and have read the following items of information:
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TASQ cannot guarantee that 100% of IVF rederivations will result in live births.
TASQ will transfer up to 60 embryos per round of IVF. TASQ cannot guarantee that 100% of embryo
transfers will result in live births.
TASQ charges apply for each round of rederivation. More than one round may be necessary for
successful rederivation.
TASQ will not cull excess donors/studs held at UQ until requested by researcher.
Courier costs are the responsibility of the client.
Agistment charges will apply once the resulting progeny are weaned.
A Colony Management levy may apply to those rederived lines needing expanding prior to
shipment.
Female/male wild type mice can be ordered for matings with costs the responsibility of the client
Have obtained an Animal Ethics approval and quoted this number and expiry date, as explained in
the above document.
Have obtained OGTR approval and quoted this number.
The generation of this genetically modified mouse strain will not infringe any intellectual property
rights.
I have checked the TASQ website at http://tasq.uq.edu.au and agree to the charges listed for this
service.
Signature of Chief Investigator: ..................................................
Elizabeth Williams
Manager, TASQ
University of Queensland Biological Resources
AIBN Building 75
Cnr Cooper & College Rds
University of Queensland
St Lucia QLD 4072, Australia
Tel: +61 7 3346 3468
Email: Elizabeth.williams@uq.edu.au
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Date: .............................
Tracy Doan
Rederivation and Cryopreservation Co-Ordinator
University of Queensland Biological Resources
University of Queensland
St Lucia QLD 4072, Australia
Email: t.doan1@uq.edu.au