Transgenic Research Center In the Cancer Center

Service Requisition Form

Teratom formation and analysis


Which service?

Contact Data:


Date: Requestor Name:
Dept: PI:
Lab location    


Billing Account Information:

Project#  (eg, 1234567)
Task# (eg, 100)
Award (rg, ACAEH)

NCI Funded?  Is PI a Cancer Insitute member? 
Name of person who has authorization over the account: 

A-PLAC protocol #:  
Animal Housing Location:   
Cell line name and species  
Have the cells been tested for mouse pathogen, including mycoplasma?

If yes, please provide us the test report. If not, we will send the cells out for testing for you.

Please provide information on whether the cell line has been genetically modified. If so, what is the modification method, e.g. lentivirus.


Project description and special requirements:


Footer Links: