Laboratory (PI):

Contact Investigator:

CBC Protocol Number:

Account# (*full PTAEO required!)
(Project/Task/Award/Expenditure/Org):

Phone:

E-mail:

Male Information

Male Strain Name:

Genotype:

Male Genetic Background::

Male age:

Number of Males submitted:

Original Housing Room Number:

Health Status of the Room/Date Last Checked by CBC:

Frozen Sperm

Vials/Straws: Straws Vials

NB Volume suggestion ICSI≥10µl:

Female (Embryo Donors) Information

Genetic background of female (embryo donors) strain:

Genotype:

Desired vendor: JAX Taconic Farms Charles Rivers Lab

Sperm thawing protocol MUST be provided.