GCCRI Patient-Derived Xenograft Core (External)


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

External Material Transfer Request

1. Type of MTA

Is the agreement

2. UT Health SA Information

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

3. Second Party Information (If you are providing a Material to a for-profit Second Party stop here. Submit your request to the Office of Technology and Commercialization at otcinfo@uthscsa.edu with a copy to eary@uthscsa.edu)

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

4. 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.)?
Are the samples de-identified?
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?
Is this transaction part of a collaboration (not including authorship or acknowledgment)?
If yes, is there an existing collaboration agreement in place?
If this is part of a collaboration, are there more participants than the Second Party listed here:

5. For OUTGOING MTA

What is the source of funds under which the materials were made?
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?

https://otc.uthscsa.edu/information-for-inventors/

6. For Incoming MTA

What is the source of funds for the research in which the material is to be used?kboxes
Will any modification be created out of the material (substance that contains or incorporates the material or is crossbred with your own materials?
Will any derivatives of the material be created?
Do you intend to publish the findings of your research using the materials?
If yes, are you willing to allow the provider a chance to review a manuscript or other draft publication in advance of submission?
Do you have a financial interest in the provider organization (income, consulting, stock ownership, etc)?
If yes, has this interest been disclosed to the institution via the iDisclose system here: (vpr.uthscsa.edu/iDisclose/).
Could the use of the incoming material(s) result in a finding that may be of commercial value?
Will the Material be used with or combined with existing UT Health SA materials?
Has the material been disclosed to the Office of Technology and Commercialization?
Have you been provided a draft MTA from the provider?

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