Loyola University Transgenic Core Facility & Custom Surgical Services
Section of Comparative Medicine
2160 S. First Avenue
Building 101, Rm.0745
Maywood, IL 60153
TEL: (708)216-8316
FAX: (708)216-5934

TRANSGENIC INJECTION REQUEST FORM

Please answer each line of the request form. If you are unable to give a specific answer, type in "no info" in the space provided.

Investigator:

Department:

Contact Name:

Telephone Number:

Source of Funding:

Account Number:

IACUC Number:

Approval Date:

Business Administrator:

Telephone Number

Construct:

Promoter/Enhancer:

Concentration:

Amount:

  Yes  No   Has this regulatory element been proven to produce tissue-specific expression in transgenic mice?
If so, what tissue?
How was the DNA purified?
DNA tube label reads:

Please submit the following information:
1. Printed this request form with signature below.
2. A brief description of your project and its aim.
3. A linker map indicating the promoter/enhancer location, splice site and CAP size.
4. Copies of the approval letter from IACUC committee.

Investigator's signature ________________________________________
                              Date  ___________________
                  Received by __________________________________
                              Date  ___________________

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