Eunice Kennedy Shriver National Institutes of Health/National Institute of Child Health and Human Development Distribution NICHD)/National Institutes of Health (NIH) Distribution Mouse Models for Chromosomal Disorders

The Cytogenetics and Down Syndrome Mouse Models Resource is funded by an NICHD/NIH contract and administered by The Jackson Laboratory. All requests for mice are reviewed by NICHD Program Officers. Special consideration regarding inventory allotment and price is given to those investigators with federal funding pursuant to the study of Down syndrome or related research. It is required that all investigators requesting mice fill out the request form below. You will be contacted by customer service to finalize the specifics of your order before it is placed. Approval of a request does not guarantee that an order will be fulfilled exactly as it is requested, as orders will be filled based on strain availability and need to maintain the colony.

Please place your order with the JAX Customer Service Department at 1-800-422-MICE or (207) 288-5845, or fax to 207-288-6150, before completing this form. Please include the JAX Sales number we provide on this form.

PLEASE NOTE:

This online form may not function in all locations. As an alternative, please use this PDF-based version if needed. Please send completed forms to this email alias: cytogenetics@jax.org

I. Scientific Request Information

A: General Requester Information

General Information

Investigator's First Name

Investigator's Last Name

Institution

Address

Address 2

City

State/Province

Zip/Postal Code

Country

Telephone

Fax

B: Funding source (e.g., National Institutes of Health, Howard Hughes, etc). Please avoid the use of undefined acronyms.

Funding source

If you do not have a funding source for the project, please indicate none.

If not U.S.-based, please provide a weblink to the funding source

Grant or contract number

If you do not have a funding source for the project, please indicate none.

JAX Sales Order Number

C. Research project description

Research Project Title

Please describe your research project below:

D. Published work using mice from this resource

Are you a first time user of this resource?

YesNo

If you have previously used mice from this resource, please list the citations for publications that have resulted from this work. (If your citations are extensive, you can upload a separate attachment.)

Please attach separate documents here:

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Cytogenetics and Down Syndrome Models Resource Request for Animals Form

I. Scientific Request Information

II. Animals Requested

III. Other Information

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