If another lab is sending you research materials and you need an MTA, please fill out this form.
* indicates required fields.
Principal Investigator *
Lab Contact/Admin Name & E-mail
Material Provider Name & E-mail *
Describe/list the Material(s) you wish to receive. Please indicate whether the Material is a cell line, plasmid, mouse, etc.
How will you use the Material?
Federal contract(s) or grant(s)
Other. Please describe:
Specify the name(s) of the above funding source(s) for your research project:
Serving on an Advisory Board or Board of Directors
Ownership of stock or stock options
Human stem cell, embryos, or oocytes (SCRO)
Live vertebrate animals (APLAC)
Obtained from a living person (IRB)
Radiologically hazardous (CRA/SMN)
rDNA non-exempt under NIH guidelines (APB)
Infectious or Biohazardous (APB)
Please provide protocol #(s) for the above selection(s) (or enter N/A for none):
Attach the Word version of the MTA, if available. Do not have the PI sign the MTA until it has been reviewed by ICO:
Your E-mail *
Special instructions for us:
After you click “Submit Form” below, you will receive an email confirmation. We will contact the Principal Investigator and individual(s) identified as the Lab Contact/Admin about next steps. For questions, please contact firstname.lastname@example.org.
Please skip. Do not fill this out.