LASP logo   NCI-Frederick
  clear pixel clear pixel

Cryopreservation and Assisted Reproduction Laboratory - Request for Services

Please note that a separate form needs to be completed for each strain.

Contact Information

Principal Investigator:
Center Number:
Phone No: Fax No:
Building: Room:

Type of Service(s) Requested

Cryopreservation: Embryo Sperm Ovary
Reproduction: Colony Expansion Special Rederivation
Strain Reconstitution from: Embryos Sperm Ovary

Current Location of Colony

Mice currently available: Yes No
Contact person in animal facility:

Laboratory Animal Model to be Sent or Reconstituted

Strain Nomenclature:
Short Name:
Coat Color: Age:
  Transgenic Knockout Mutant
Strain Background:
  Hybrid Inbred Mixed
Phenotypic Expression:
Is your strain genetically engineered?

Yes No

Was a virus or plasmid used in creating this strain?
Yes No
If yes, please provide name of virus or plasmid vector.
What gene or genes are being expressed or have been modified?
Are there any potential risks to animal workers associated with this strain?
Yes No
If yes, please explain those risks.
If applicable, please provide NCI-Frederick Institutional Biosafety Committee
Registration Number.   
Genotype:  Heterozygous Homozygous
Indicate best method to verify genotypic expression:

Method of breeding and reproductive performance:
Special Requirements/ Notes:

PCR Information

Beginning Fiscal Year 2005, the cryopreservation and Assisted Reproduction laboratory will be offering genotyping by PCR that follows the quality control procedure for sperm, embryo, and ovary cryopreservation. This is to expedite the genotyping process and to reduce turn around time for all cryopreservation requests. For this purpose, please provide the primers along with the following information:

Sequence of the Primers:
Concentration of the Primers:
Melting Temperature (Tm), °C:
Expected size of the amplified fragment:
A representative picture of the PCR product:

  National Cancer Institute (NCI)      National Institutes of Health (NIH)      Department of Health and Human Services (HHS)