If another lab is sending you research materials and you need an MTA, please fill out this form.
* indicates required fields.
Principal Investigator *
Lab Contact/Admin Name & E-mail *
Provider Institution/Company Name *
Material Provider Name & E-mail *
Describe/list the Material(s) you wish to receive. Please indicate whether the Material is a cell line, plasmid, mouse, etc.
How will you use the Material?
Human stem cell, embryos, or oocytes (SCRO)
Infectious or Biohazardous (APB)
Live vertebrate animals (APLAC)
Obtained from a living person (IRB)
Radiologically hazardous (CRA/SMN)
rDNA non-exempt under NIH guidelines (APB)
Please provide protocol #(s) for the above selection(s)
Federal contract(s) or grant(s)
Name the above funding source(s) for your research project
Advisory Board Member or Board of Directors
Ownership of stock or stock options
Attach the Word version of the MTA, if available. Do not have the PI sign the MTA until it has been reviewed by ICO:
Your E-mail *
After you click “Submit Form” below, you will receive an e-mail confirmation. We will contact the Principal Investigator and individual(s) identified as the Lab Contact/Admin about next steps. For questions, please contact: firstname.lastname@example.org
Please skip. Do not fill this out.