Contact Person: Fax: IACUC Protocol Title: Address: Department: Yes. Primers Name: Concentration: Fragment Size:

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1 Transgenic Mouse Request Form Please attach a gel photo and a linear map of the construct to this form. The map should indicate locations of: Promoter/ enhancer, splice site, poly A site, and CAP site. Please submit copies of the approval letters from the IBC and IACUC committees Phone: Bill To: Purchase Order #: Fax: Construct: Concentration: Amount: Promoter/Enhancer: Has this regulatory element been proven to Yes If yes, specify tissue: produce tissue-specific expression in transgenic mice? No Has this construct been expressed in a eukaryotic system? Yes No For cdna s: Yes If yes, specify location: Does construct contain any introns? No How was DNA purified? DNA tube label Primers Name: Concentration: Fragment Size: Where will the animals be housed? Facility: Room number: Please provide a brief description of the project and its aims below (Use attached sheet only if necessary):

2 Transgene Screening Results Failure to report results within 45 days of receiving the tail samples will result in the forfeiture of your right to a free reinjection in the event that only 0-2 founder mice can be detected Once results become available, please return this form to: Dr. Jean Richa Department of Genetics 502 Clinical Research Building / 6145 Number of mice/tails reveived from TCMF: Date: Date of biopsy analysis: Number of Transgenics: ID Number of Transgenics: Attached Documents (e.g., gel photo, autoradiogram, etc.): Project Scientist: Signature: Date:

3 Chimeric Mouse Request Form Please attach a schematic diagram of the recombination strategy and a photo of the recombination detaction analysis Please submit copies of the approval letters from the IBC and IACUC committees Bill To: Purchase Order #: Fax: ES cell line: Passage Number; Has this cell line been tested for chimerism prior to recombination? Yes No If No, please explain: Brief description of the project and it s aims: (Use attached sheet if necessary)

4 Genome-edited Mouse Request Form Please attach any documentation on the grna s and the mutation site(s). Please submit copies of the approval letters from the IBC, and IACUC committees Investigator: Address: Telephone: Contact Person: Phone: Department: Fax: Fax: IACUC Protocol Title: IACUC Protocol Number: IBC Number: BA s Name: Address: IACUC Approval Date: IBC Approval Date: Telephone: Department: Purchase Order #: Fax: RNA Project: Concentration of Cas9 RNA: Number of grna: Number of Oligo DNA: Number of dsdna Template: Deletion Size: Mouse Strain: How was RNA Purified? Cas9 Protein: Concentration: Concentration: Concentration: Insertion Size: Number of Insertions: RNA Tube label: Primers Name: Primer Concentration (µm) Fragment size(bp) Please provide a brief description of the project and its aims below (Use attached sheet only if necessary): Investigator s Signature: Date: Received By: Date:

5 Embryo Cryopreservation Request Form Bill To: Purchase Order #: Fax: Mouse Line(s) Identification Number(s): Where will the animals be housed? Facility: Room Number: Would the proposed number of embryos to be frozen be sufficient for your lines? Yes No If No, please explain:

6 Mouse Line Rederivation Request Form Bill To: Purchase Order #: Fax: Mouse Line(s) Identification Number(s): Where will the animals be housed? Facility: Room number: Would the proposed number of embryos transferred be sufficient for your lines? Yes No If No, please explain:

7 Sperm Cryopreservation Request Form Business Administrator: Purchase Order #: Fax: Mouse Line(s) Identification Number(s): Where will the animals be housed? Facility: Room number: Will you require training in organ harvesting? Yes No (If Yes, please contact the Facility at to make arrangements for training.)

8 In-Vitro Fertilization Request Form Bill To: Telephone: Purchase Order #: Fax: Mouse Line(s) Identification Number(s): Where will the animals be housed? Facility: Room number: Will you require training in organ harvesting? Yes No (If Yes, please contact the Facility at to make arrangements for training.)