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Thursday Oct 9
Rodent Handling Session

Laboratory Animal Science Center, LASC

Request to Import Rodents

This form is to be used to import rodents from a collaborative institution into Boston University Medical Center, BUMC; All animals will be quarantined at BUMC Quarantine Facility and transferred to an established animal colony facility upon clearance from quarantine.

In order to receive animals, The LASC require appropriate health reports for one year duration representing the site at original institution.; A letter from the institutional veterinarian detailing the animal care program must accompany the health reports.

Please fill out all appropriate areas throughout this document.; Incomplete forms will be administratively returned; If questions, contact LASC Office, 617-638-4086.

Recipient Information Principal Investigator (PI) Name: Department: Telephone: Fax: Email: Contact Person: Contact Person Telephone: Contact Person Fax: Contact Person Email: Q# (assigned by BUMC/LASC):

Animal Use

Animals will be used for (check all that apply):

Acute/terminal use in Quarantine (e.g. tissue harvest)

Breeding at BUMC (limited and subject to LASC & IACUC approval)

Quarantine ONLY, no breeding

Rederivation

Other (briefly explain):

Responsible for Shipping Costs:
IACUC Protocol Number: Source to charge QUARANTINE costs:
Desired Animal Arrival Date:
Intended housing site after quarantine:
Room Number:

Sender/Donor Information Principal Investigator (PI) Name: Department: Telephone: Fax: Email: Contact Person: Telephone: Fax: Email: Institution Name: Department: Address line 1: Address line 2: City: State: Zip Code: Attending Veterinarian: Veterinarian Email: Veterinarian Phone: Veterinarian Fax: Shipping paid by sender:
Yes No Shipping Contact (Name): Account: Shipping Contact Phone:

Animal Information Species: Mouse Rat Strain: Background strain if Tg: Total to be shipped: Number of Females: Number of Males:

Method of Animal ID:

Ear Tag Ear Punch Markings

ID#:

Animal Conditions and Past Procedures:

Tail Snip Ear Tag Ear Punch

Current Housing Location (bldg/room): Current Housing Mode: Health Summary: Other:

Genotype information: Mutant KO Tg

Immune System: Normal Deficient Unknown

Phenotype information: Expected Breeding Life Spontaneous Tumors
Immunodeficiency Behavior
Metabolic Abnormalities
Other:

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