Greehey CCRI Patient-Derived Xenograft Core (Internal)


Provider Information:

Anna Rogojina, PhD
Technical Director, PDX Core Facility
Greehey CCRI
UT Health San Antonio
8403 Floyd Curl Dr., MC 7784
San Antonio, TX 78229
210-562-9001
rogojina@uthscsa.edu

PDX Internal Material Transfer Request

Recipient Scientist Information

RECEPIENT Address
RECEPIENT Address
City
State/Province
Zip/Postal
Country

Material Information

Is the material available commercially or through any other source such as a research reagent bank or depository (ATCC, Hybridoma Bank, etc)?
Does the material contain GFP or EGFP?
Is the material being used with (an)other material(s) received under an MTA?
Is the material a human sample (blood, serum, plasma, urine, stool, tissue, etc.)?
Is the material a whole animal?
Is the material a recombinant DNA, infectious agent or export controlled agent?
Based on the previous question, are the appropriate committee approvals in place?
If this is part of a collaboration, are there more participants than the Second Party listed here:
If you answered the previous question "yes", is there an existing collaboration agreement in place?

Additional Information

What is the source of funds under which the materials were made? (Check ALL that apply)
Was the material created at UT Health SA?
Are you the creator/inventor of the material?
If the material was created at UT Health SA, has the material been disclosed to the Office of Technology and Commercialization?
OTM
Do you require an authorship credit or acknowledgement in any recipient publications?
Do you require prior review of any publications?
Should the material be returned or destroyed upon completion of the Study?
Shipping Address for the Material:
Shipping Address for the Material:
City
State/Province
Zip/Postal
Country