Request for Service (Internal Users)

Principal Investigator
Laboratory Contact Person
 
Material For Testing
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)
Tissue distribution of mutation

If Tissue-specific, check all that apply:

Number and location of mice/cages


Gender
Age
Proposed date of transport

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 ).