Request for Service (Internal Users)

Principal Investigator

Department

Last Name

First Name

Email

Phone Number

Fax Number 

Docket Number

Speed Type
Laboratory Contact Person

Last Name

First Name

Email


Phone Number


Facility - Room where mice are currently housed

Material For TestingMice Sample
Mouse identifier (strain name used in the laboratory)
Background genetic strain of mice
Backcross history (generations)
Affected locus (all information will be kept confidential)
    

Nature of genetic manipulation
(check all that apply)

Knockout Knock-in Overexpression
Floxed Cre Others
Tissue distribution of mutation
If Tissue-specific, check all that apply:
Skeletal Muscle Adipose Tissue
Liver Cardiovascular System
Brain Islet b-cells
Bone Pulmonary system
GI System Endocrine System
Immune System Others

Number and location of mice/cages

Control mice,  Experimental mice, Number of cages


Facility and room number where mice are currently housed

Gender
Age Date of Birth
Proposed date of transport Date
Proposed studies

Please download the attached IACUC Application to Use UMPC and Minor Amendment Form and submit the completed forms to the IACUC office (angela.muise@umassmed.edu).

   

 Overview Mice2