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Principal Investigator *
SU Lab Contact/Admin Name & E-mail *
Collaborator Institution/Company Name *
Collaborator Contact Name & E-mail *
Will you use the Collaborator's Material with other proprietary materials from companies and were agreements signed for the other materials? If so, what are the other materials and who provided them?
Human stem cell, embryos, or oocytes (SCRO)
Radiologically hazardous (CRA/SMN)
Obtained from a living person (IRB)
Live vertebrate animals (APLAC)
Infectious or Biohazardous not including Viral Vectors (APB)
rDNA non-exempt under NIH guidelines (APB)
By checking this box, I confirm that the material is covered under an approved APB protocol.
FOR APLAC - Please describe how the material(s) will be used in live animals. For new rodent strains, please describe the known phenotypes of each strain (that is, why the strain will be used for your study), and include any detrimental phenotypes that may require special care or monitoring.
Please provide protocol #(s) for the above selection(s)
Industrial Affiliates Program
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
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: email@example.com
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