{"id":2037,"date":"2025-08-13T09:47:21","date_gmt":"2025-08-13T13:47:21","guid":{"rendered":"https:\/\/www.bu.edu\/research\/?post_type=forms-policies&#038;p=2037"},"modified":"2025-12-18T13:35:56","modified_gmt":"2025-12-18T18:35:56","slug":"material-transfer-agreement-mta-request","status":"publish","type":"forms-policies","link":"https:\/\/www.bu.edu\/research\/forms-policies\/material-transfer-agreement-mta-request\/","title":{"rendered":"Material Transfer Agreement (MTA) Request: Outgoing MTAs"},"content":{"rendered":"<div class=\"important ban\"><div class=\"important-wrap\"><p> <strong>New:<\/strong> NIH policy on Enhancing Security Measures for Human Biospecimens, NIH- NOT-OD-25-160, effective October 24, 2025, prohibits an entity (eg., biorepository, institution, investigator) that holds human biospecimens of U.S. persons collected, obtained, stored, used, or distributed using on-going or new NIH funds from directly or indirectly distributing the human biospecimens to institutions or parties located in countries of concern (presently including China, Russia, North Korea, Iran, Cuba, and Venezuela). The MTA Request Form has been revised to include questions to determine whether your requested MTA material is subject to this NIH policy. <\/p><\/div><\/div>\n<p>BU encourages researchers to exchange non-hazardous or non-human research materials for nonprofit, basic research purposes without a formal legal agreement, when practicable. If you are unsure whether an MTA is needed, please review the information under <a href=\"https:\/\/www.bu.edu\/research\/collaboration-partnership\/industry-collaboration\/material-transfer-agreements\/\">Outgoing Material Transfer Agreements<\/a>.<\/p>\n<h2 id=\"instructions\">Instructions<\/h2>\n<ul>\n<li>This is a smart form and must be filled out electronically.<\/li>\n<li>Please complete the information and questionnaire below. Required fields are marked. All other fields are optional.<\/li>\n<li>Clicking \u201cyes\u201d on some check boxes will display additional mandatory fields to be completed.<\/li>\n<li>You can save a copy of the form at any time using the Save button and complete the form later.<\/li>\n<li>Submit the form by clicking the Submit button and following the prompts. This will send a copy of the form to Technology Development (OTD) via your normal email. Please note, the submit process will not work until all required fields are filled out.<\/li>\n<li>OTD will confirm receipt and review the form and initiate the agreement review process. Please contact mtaout@bu.edu if you do not receive a confirmation within three (3) business days.<\/li>\n<li>Please note, based on answers to questions in the form, the following groups may also receive notification of the request and could contact you directly regarding the request:\n<ul>\n<li>Institutional Review Board (IRB)<\/li>\n<li>Export Control<\/li>\n<li>National Emerging Infectious Diseases Laboratory (NEIDL)<\/li>\n<li>Animal Science Center (ASC) \/ Institutional Animal Care and Use Committee (IACUC)<\/li>\n<\/ul>\n<\/li>\n<li>First time here? <a href=\"https:\/\/www.bu.edu\/research\/collaboration-partnership\/industry-collaboration\/material-transfer-agreements\/\">Learn more<\/a> about MTAs and how to use this form.<\/li>\n<\/ul>\n<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_210' style='display:none'>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_210'  action='\/research\/wp-json\/wp\/v2\/forms-policies\/2037' data-formid='210' >\n                        <div class='gform-body gform_body'><ul id='gform_fields_210' class='gform_fields top_label form_sublabel_above description_above'><li id=\"field_210_139\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_139\"><h2>Outgoing Material Transfer Agreement<\/h2><\/li><li id=\"field_210_149\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_149\">BU encourages researchers to exchange non-hazardous or non-human research materials for nonprofit, basic research purposes without a formal legal agreement, when practicable. If you are unsure whether an MTA is needed, please review the information under <a href=\"https:\/\/www.bu.edu\/research\/collaboration-partnership\/industry-collaboration\/material-transfer-agreements\/\">Outgoing Material Transfer Agreements at Material Transfer Agreements<\/a>. <\/li><li id=\"field_210_147\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_147\"><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_210_146\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_146\"><img src=\"https:\/\/www.bu.edu\/\/research\/files\/2025\/06\/Addgene-logo.jpg\" alt=\"Addgene company logo\" \/><\/li><li id=\"field_210_141\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_141\"><strong>NOTE:<\/strong>\nIf you are looking to deposit plasmids to Addgene, instead of submitting this form, please go to <a href=\"https:\/\/www.addgene.org\/depositing\/start-deposit\/\">Addgene: Start Plasmid Deposit<\/a> and follow the Addgene deposit process. During this process, Addgene will send you a questionnaire for you to provide the relevant information needed to complete the diligence for your deposit. A copy of your answers to this questionnaire will be sent to OTD along with the details of the deposit request.<\/li><li id=\"field_210_148\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_148\"><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_210_3\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_3\"><h2 class=\"gsection_title\">1. BU\/BMC Contact Information:<\/h2><\/li><li id=\"field_210_1\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_1\"><label class='gfield_label gform-field-label' for='input_210_1' >BU\/BMC Principal Investigator (PI) Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_210_1' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_210_5\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_5\"><label class='gfield_label gform-field-label' for='input_210_5' >BU\/BMC PI Department:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_210_5' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_210_6\"  class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_6\"><label class='gfield_label gform-field-label' for='input_210_6' >BU\/BMC PI Phone:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_6' id='input_210_6' type='text' value='' class='medium'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_210_7\"  class=\"gfield gfield--type-email gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_7\"><label class='gfield_label gform-field-label' for='input_210_7' >BU\/BMC PI Email:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_7' id='input_210_7' type='text' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_210_10\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_10\"><label class='gfield_label gform-field-label' for='input_210_10' >BU\/BMC PI Lab Location<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_210_10'>(Include room, street, and ZIP code.)<\/div><div class='ginput_container ginput_container_text'><input name='input_10' id='input_210_10' type='text' value='' class='medium'  aria-describedby=\"gfield_description_210_10\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_210_11\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_above gfield--no-description field_description_above hidden_label gfield_visibility_visible\"  data-js-reload=\"field_210_11\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Check here if any\/all of BU\/BMC development of the MATERIAL was done in another lab than the Lab Location above.<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_210_11'><li class='gchoice gchoice_210_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.1' type='checkbox'  value='Check here if any\/all of BU\/BMC development of the MATERIAL was done in another lab than the Lab Location above.'  id='choice_210_11_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_210_11_1' id='label_210_11_1' class='gform-field-label gform-field-label--type-inline'>Check here if any\/all of BU\/BMC development of the MATERIAL was done in another lab than the Lab Location above.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_12\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_12\"><label class='gfield_label gform-field-label' for='input_210_12' >BU\/BMC location of where MATERIAL was developed\/produced:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_210_12'>(Include room, street, and ZIP code.)<\/div><div class='ginput_container ginput_container_text'><input name='input_12' id='input_210_12' type='text' value='' class='medium'  aria-describedby=\"gfield_description_210_12\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_210_13\"  class=\"gfield gfield--type-checkbox gfield--type-choice field_sublabel_above gfield--no-description field_description_below hidden_label gfield_visibility_visible\"  data-js-reload=\"field_210_13\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >Check here if to specify an alternate BU\/BMC contact besides the PI.<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_210_13'><li class='gchoice gchoice_210_13_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_13.1' type='checkbox'  value='Check here if to specify an alternate BU\/BMC contact besides the PI.'  id='choice_210_13_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_210_13_1' id='label_210_13_1' class='gform-field-label gform-field-label--type-inline'>Check here if to specify an alternate BU\/BMC contact besides the PI.<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_14\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_14\"><label class='gfield_label gform-field-label' for='input_210_14' >Alternate BU\/BMC Contact Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_210_14' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_210_15\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_15\"><label class='gfield_label gform-field-label' for='input_210_15' >Alternate BU\/BMC Contact Email:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_210_15' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_210_16\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_16\"><h2 class=\"gsection_title\">2. External Party (RECIPIENT) who will be participating in the exchange of the Materials:<\/h2><\/li><li id=\"field_210_17\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_17\"><label class='gfield_label gform-field-label' for='input_210_17' >RECIPIENT Institution Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_210_17' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_210_18\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_18\"><label class='gfield_label gform-field-label' for='input_210_18' >RECIPIENT PI:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_210_18' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_210_21\"  class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_21\"><label class='gfield_label gform-field-label' for='input_210_21' >RECIPIENT PI Phone:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_21' id='input_210_21' type='text' value='' class='small'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_210_20\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_20\"><label class='gfield_label gform-field-label' for='input_210_20' >RECIPIENT PI Email:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_210_20' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_210_152\"  class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_152\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >RECIPIENT PI Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_210_152' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_210_152_1_container' >\n                                        <label for='input_210_152_1' id='input_210_152_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_152.1' id='input_210_152_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_210_152_2_container' >\n                                        <label for='input_210_152_2' id='input_210_152_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_152.2' id='input_210_152_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_210_152_3_container' >\n                                    <label for='input_210_152_3' id='input_210_152_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_152.3' id='input_210_152_3' value=''    aria-required='true'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_210_152_4_container' >\n                                        <label for='input_210_152_4' id='input_210_152_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                        <input type='text' name='input_152.4' id='input_210_152_4' value=''      aria-required='true'    \/>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_210_152_5_container' >\n                                    <label for='input_210_152_5' id='input_210_152_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                    <input type='text' name='input_152.5' id='input_210_152_5' value=''    aria-required='true'    \/>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_210_152_6_container' >\n                                        <label for='input_210_152_6' id='input_210_152_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                        <select name='input_152.6' id='input_210_152_6'   aria-required='true'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option> <\/select>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_210_23\"  class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_23\"><label class='gfield_label gform-field-label' for='input_210_23' >RECIPIENT Administrative Contact:<\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_210_23' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_210_25\"  class=\"gfield gfield--type-phone field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_25\"><label class='gfield_label gform-field-label' for='input_210_25' >RECIPIENT Administrative Contact Phone:<\/label><div class='ginput_container ginput_container_phone'><input name='input_25' id='input_210_25' type='text' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_210_26\"  class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_26\"><label class='gfield_label gform-field-label' for='input_210_26' >RECIPIENT Administrative Contact Email:<\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_210_26' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_210_153\"  class=\"gfield gfield--type-address gfield--width-full field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_153\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >RECIPIENT Administrative Address<\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_210_153' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_210_153_1_container' >\n                                        <label for='input_210_153_1' id='input_210_153_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                        <input type='text' name='input_153.1' id='input_210_153_1' value=''    aria-required='false'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_210_153_2_container' >\n                                        <label for='input_210_153_2' id='input_210_153_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                        <input type='text' name='input_153.2' id='input_210_153_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_210_153_3_container' >\n                                    <label for='input_210_153_3' id='input_210_153_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_153.3' id='input_210_153_3' value=''    aria-required='false'    \/>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_210_153_4_container' >\n                                        <label for='input_210_153_4' id='input_210_153_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                        <input type='text' name='input_153.4' id='input_210_153_4' value=''      aria-required='false'    \/>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_210_153_5_container' >\n                                    <label for='input_210_153_5' id='input_210_153_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                    <input type='text' name='input_153.5' id='input_210_153_5' value=''    aria-required='false'    \/>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_210_153_6_container' >\n                                        <label for='input_210_153_6' id='input_210_153_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                        <select name='input_153.6' id='input_210_153_6'   aria-required='false'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option> <\/select>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_210_29\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_29\"><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_210_28\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_28\"><label class='gfield_label gform-field-label' for='input_210_28' >3a) Description of the Material being sent by BU\/BMC:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_28' id='input_210_28' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_210_154\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_154\"><label class='gfield_label gform-field-label'  >3b) Is this Outgoing MTA request related to a BU research award?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_210_154'>\n\t\t\t<li class='gchoice gchoice_210_154_0'>\n\t\t\t\t<input name='input_154' type='radio' value='Yes'  id='choice_210_154_0'    \/>\n\t\t\t\t<label for='choice_210_154_0' id='label_210_154_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_210_154_1'>\n\t\t\t\t<input name='input_154' type='radio' value='No'  id='choice_210_154_1'    \/>\n\t\t\t\t<label for='choice_210_154_1' id='label_210_154_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_155\"  class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_155\"><label class='gfield_label gform-field-label' for='input_210_155' >3c) Description of the related BU research award, including PI, Sponsor, Title and Award #:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_155' id='input_210_155' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_210_90\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_90\"><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_210_30\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_30\"><label class='gfield_label gform-field-label' for='input_210_30' >4) Description of Research to be conducted by Recipient with the Material:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_30' id='input_210_30' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_210_91\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_91\"><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_210_112\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gf_list_5col gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_112\"><label class='gfield_label gform-field-label'  >5) Is the RECIPIENT located outside of the U.S.?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_210_112'>\n\t\t\t<li class='gchoice gchoice_210_112_0'>\n\t\t\t\t<input name='input_112' type='radio' value='Yes'  id='choice_210_112_0'    \/>\n\t\t\t\t<label for='choice_210_112_0' id='label_210_112_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_210_112_1'>\n\t\t\t\t<input name='input_112' type='radio' value='No'  id='choice_210_112_1'    \/>\n\t\t\t\t<label for='choice_210_112_1' id='label_210_112_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_130\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_130\"><b>Export Information Checklist<FONT COLOR=\"#ff0000\"> *<\/FONT><\/b>\n<p>\nExport control laws are federal regulations that define the conditions under which\ncertain information, technologies, software, and commodities can be transmitted to foreign corporations, organizations or individuals overseas (including U.S. citizens). If you are providing information overseas, the information (or the medium on which it is transmitted) may be subject to federal regulation. Before answering these questions, you should review the University\u2019s <a href=\"https:\/\/www.bu.edu\/research\/ethics-compliance\/research-security\/export-control\/\">Export Control web site<\/a>. Please complete the following Export information checklist. If you are UNABLE to confirm any of these statements or have any questions, contact the Export Control Director at <a href=\"mailto:export@bu.edu\">export@bu.edu<\/a>.\n<\/p><\/li><li id=\"field_210_133\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gf_list_5col gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_133\"><label class='gfield_label gform-field-label'  >I have confirmed that the MATERIAL is not designed or adapted for a military or space application and does not relate to and will not be used in connection with weapons of mass destruction, nuclear activities and research, space launch vehicles, unmanned air vehicles, or maritime nuclear propulsion.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_210_133'>\n\t\t\t<li class='gchoice gchoice_210_133_0'>\n\t\t\t\t<input name='input_133' type='radio' value='Yes'  id='choice_210_133_0'    \/>\n\t\t\t\t<label for='choice_210_133_0' id='label_210_133_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_210_133_1'>\n\t\t\t\t<input name='input_133' type='radio' value='No'  id='choice_210_133_1'    \/>\n\t\t\t\t<label for='choice_210_133_1' id='label_210_133_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_134\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gf_list_5col gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_134\"><label class='gfield_label gform-field-label'  >I have confirmed that NO \u201cred flags\u201d from the Department of Commerce\u2019s Bureau of Industry and Security (BIS) Red Flag Indicator list  are present.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_210_134'><a href=\"https:\/\/www.bis.gov\/regulations\/ear\/732#supplement-3-732\">Bureau of Industry and Security (BIS) Red Flag Indicator list<\/a><\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_210_134'>\n\t\t\t<li class='gchoice gchoice_210_134_0'>\n\t\t\t\t<input name='input_134' type='radio' value='Yes'  id='choice_210_134_0'    \/>\n\t\t\t\t<label for='choice_210_134_0' id='label_210_134_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_210_134_1'>\n\t\t\t\t<input name='input_134' type='radio' value='No'  id='choice_210_134_1'    \/>\n\t\t\t\t<label for='choice_210_134_1' id='label_210_134_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_135\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gf_list_5col gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_135\"><label class='gfield_label gform-field-label'  >I have confirmed that the information or material to be transferred does not appear on the Commerce Control List (CCL)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_210_135'><a href=\"https:\/\/www.bis.gov\/regulations\/ear\/774\">Commerce Control List<\/a><\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_210_135'>\n\t\t\t<li class='gchoice gchoice_210_135_0'>\n\t\t\t\t<input name='input_135' type='radio' value='Yes'  id='choice_210_135_0'    \/>\n\t\t\t\t<label for='choice_210_135_0' id='label_210_135_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_210_135_1'>\n\t\t\t\t<input name='input_135' type='radio' value='No'  id='choice_210_135_1'    \/>\n\t\t\t\t<label for='choice_210_135_1' id='label_210_135_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_136\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gf_list_5col gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_136\"><label class='gfield_label gform-field-label'  >I have confirmed that the information or material to be transferred does not appear on the U.S. Munitions List.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_210_136'><a href=\"https:\/\/www.ecfr.gov\/current\/title-22\/chapter-I\/subchapter-M\/part-121\">U.S. Munitions List<\/a>\n<br\/>\n(You should review both the CCL and the Munitions List online if the material you plan to transfer fits within one of the categories. If the information\/technology, materials\/software that you plan to transfer are on any of these lists, contact the University Export Control Director export@bu.edu to help you determine whether an export license is required for this transfer.)<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_210_136'>\n\t\t\t<li class='gchoice gchoice_210_136_0'>\n\t\t\t\t<input name='input_136' type='radio' value='Yes'  id='choice_210_136_0'    \/>\n\t\t\t\t<label for='choice_210_136_0' id='label_210_136_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_210_136_1'>\n\t\t\t\t<input name='input_136' type='radio' value='No'  id='choice_210_136_1'    \/>\n\t\t\t\t<label for='choice_210_136_1' id='label_210_136_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_106\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_106\"><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_210_113\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gf_list_5col gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_113\"><label class='gfield_label gform-field-label'  >6) Will you charge the RECIPIENT a fee (other than shipping\/handling) for the transfer?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_210_113'>\n\t\t\t<li class='gchoice gchoice_210_113_0'>\n\t\t\t\t<input name='input_113' type='radio' value='Yes'  id='choice_210_113_0'    \/>\n\t\t\t\t<label for='choice_210_113_0' id='label_210_113_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_210_113_1'>\n\t\t\t\t<input name='input_113' type='radio' value='No'  id='choice_210_113_1'    \/>\n\t\t\t\t<label for='choice_210_113_1' id='label_210_113_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_42\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_42\"><label class='gfield_label gform-field-label' for='input_210_42' >a. Preparation\/Distribution Costs:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_210_42'>Transfer of materials to Universities and Nonprofits are normally provided at no cost, however, you may request a fee solely to reimburse preparation and distribution costs of the Material. For transfers to a commercial\/industry Recipient, you may charge additional amounts. Please specify costs\/fees below and OTD will contact you to explore possible options.<\/div><div class='ginput_container ginput_container_text'><input name='input_42' id='input_210_42' type='text' value='' class='medium'  aria-describedby=\"gfield_description_210_42\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_210_43\"  class=\"gfield gfield--type-text field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_43\"><label class='gfield_label gform-field-label' for='input_210_43' >b. Additional charges, if any (commercial only):<\/label><div class='ginput_container ginput_container_text'><input name='input_43' id='input_210_43' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_210_98\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_98\"><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_210_117\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gf_list_5col gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_117\"><label class='gfield_label gform-field-label'  >7) Will you be sending live animals as part of this transfer?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_210_117'>\n\t\t\t<li class='gchoice gchoice_210_117_0'>\n\t\t\t\t<input name='input_117' type='radio' value='Yes'  id='choice_210_117_0'    \/>\n\t\t\t\t<label for='choice_210_117_0' id='label_210_117_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_210_117_1'>\n\t\t\t\t<input name='input_117' type='radio' value='No'  id='choice_210_117_1'    \/>\n\t\t\t\t<label for='choice_210_117_1' id='label_210_117_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_54\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_54\"><label class='gfield_label gform-field-label' for='input_210_54' >a. Strain Name:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_54' id='input_210_54' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_210_55\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_55\"><label class='gfield_label gform-field-label' for='input_210_55' >b. Name and function of gene:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_55' id='input_210_55' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_210_56\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_56\"><label class='gfield_label gform-field-label' for='input_210_56' >c. Intended Use:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_210_56' type='text' value='' class='medium'    placeholder='Experimental Use Only (no breeding)' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_210_57\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_above gfield--no-description field_description_above hidden_label gfield_visibility_visible\"  data-js-reload=\"field_210_57\"><label class='gfield_label gform-field-label screen-reader-text gfield_label_before_complex'  ><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_210_57'><li class='gchoice gchoice_210_57_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_57.1' type='checkbox'  value='By checking this box, I acknowledge that I must submit an Export Request to the BUMC Laboratory Animal Science Center or CRC Laboratory Animal Care Facility as applicable.  &lt;a href=&quot;https:\/\/www.bu.edu\/research\/ethics-compliance\/animal-subjects\/&quot;&gt;(help)&lt;\/a&gt;'  id='choice_210_57_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_210_57_1' id='label_210_57_1' class='gform-field-label gform-field-label--type-inline'>By checking this box, I acknowledge that I must submit an Export Request to the BUMC Laboratory Animal Science Center or CRC Laboratory Animal Care Facility as applicable.  <a href=\"https:\/\/www.bu.edu\/research\/ethics-compliance\/animal-subjects\/\">(help)<\/a><\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_128\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gf_list_5col gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_128\"><label class='gfield_label gform-field-label'  >d. Has this use been approved by the Institutional Animal Care and Use Committee (IACUC)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_210_128'><a href=\"https:\/\/www.bu.edu\/research\/ethics-compliance\/animal-subjects\/iacuc\/\">Institutional Animal Care and Use Committee (IACUC)<\/a><\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_210_128'>\n\t\t\t<li class='gchoice gchoice_210_128_0'>\n\t\t\t\t<input name='input_128' type='radio' value='Yes'  id='choice_210_128_0'    \/>\n\t\t\t\t<label for='choice_210_128_0' id='label_210_128_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_210_128_1'>\n\t\t\t\t<input name='input_128' type='radio' value='No'  id='choice_210_128_1'    \/>\n\t\t\t\t<label for='choice_210_128_1' id='label_210_128_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_99\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_99\"><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_210_118\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gf_list_5col gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_118\"><label class='gfield_label gform-field-label'  >8) Does the material contain or is it derived from human tissue or specimens OR is the material related to research regulated by an Institutional Review Board (IRB)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_210_118'>(Please review the applicable IRB policy (<a href=\"https:\/\/www.bumc.bu.edu\/irb\/\">BUMC<\/a> and\/or <a href=\"https:\/\/www.bu.edu\/research\/ethics-compliance\/human-subjects\/\">CRC<\/a>) before answering this question)<\/div><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_210_118'>\n\t\t\t<li class='gchoice gchoice_210_118_0'>\n\t\t\t\t<input name='input_118' type='radio' value='Yes'  id='choice_210_118_0'    \/>\n\t\t\t\t<label for='choice_210_118_0' id='label_210_118_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_210_118_1'>\n\t\t\t\t<input name='input_118' type='radio' value='No'  id='choice_210_118_1'    \/>\n\t\t\t\t<label for='choice_210_118_1' id='label_210_118_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_156\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_156\"><label class='gfield_label gform-field-label'  >a) Were NIH funds used to support the collection, obtainment, creation, development, storage, use, or distribution of the material?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_210_156'>\n\t\t\t<li class='gchoice gchoice_210_156_0'>\n\t\t\t\t<input name='input_156' type='radio' value='Yes'  id='choice_210_156_0'    \/>\n\t\t\t\t<label for='choice_210_156_0' id='label_210_156_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_210_156_1'>\n\t\t\t\t<input name='input_156' type='radio' value='No'  id='choice_210_156_1'    \/>\n\t\t\t\t<label for='choice_210_156_1' id='label_210_156_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_157\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_157\"><label class='gfield_label gform-field-label'  >(i) Was the material made publicly or commercially available prior to October 24, 2025?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_210_157'>\n\t\t\t<li class='gchoice gchoice_210_157_0'>\n\t\t\t\t<input name='input_157' type='radio' value='Yes'  id='choice_210_157_0'    \/>\n\t\t\t\t<label for='choice_210_157_0' id='label_210_157_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_210_157_1'>\n\t\t\t\t<input name='input_157' type='radio' value='No'  id='choice_210_157_1'    \/>\n\t\t\t\t<label for='choice_210_157_1' id='label_210_157_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_142\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_142\"><label class='gfield_label gform-field-label'  >b) Please identify which IRB controls, and provide your IRB protocol number.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_210_142'>\n\t\t\t<li class='gchoice gchoice_210_142_0'>\n\t\t\t\t<input name='input_142' type='radio' value='BUMC'  id='choice_210_142_0'    \/>\n\t\t\t\t<label for='choice_210_142_0' id='label_210_142_0' class='gform-field-label gform-field-label--type-inline'>BUMC<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_210_142_1'>\n\t\t\t\t<input name='input_142' type='radio' value='CRC'  id='choice_210_142_1'    \/>\n\t\t\t\t<label for='choice_210_142_1' id='label_210_142_1' class='gform-field-label gform-field-label--type-inline'>CRC<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_63\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above hidden_label gfield_visibility_visible\"  data-js-reload=\"field_210_63\"><label class='gfield_label gform-field-label' for='input_210_63' >IRB Protocol Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_63' id='input_210_63' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_210_64\"  class=\"gfield gfield--type-fileupload field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_64\"><label class='gfield_label gform-field-label' for='gform_browse_button_210_64' >c) IRB Documentation<\/label><div class='gfield_description' id='gfield_description_210_64'>Please upload applicable IRB documents \ne.g., BU IRB approval letter)\n<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_210_64' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_210_64&quot;,&quot;container&quot;:&quot;gform_multifile_upload_210_64&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_210_64&quot;,&quot;filelist&quot;:&quot;gform_preview_210_64&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/www.bu.edu\\\/research\\\/?gf_page=8dc2119f6bced5e&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/www.bu.edu\\\/research\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/www.bu.edu\\\/research\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;104857600b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:210,&quot;field_id&quot;:64},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_210_64&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_210_64' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_210_64' class='button gform_button_select_files' aria-describedby=\"gfield_upload_rules_210_64 gfield_description_210_64\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_210_64'>Max. file size: 100 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_210_64'><\/ul> <!-- Leave <ul> empty to support CSS :empty selector. --><\/div><div id='gform_preview_210_64' class='ginput_preview_list'><\/div><\/li><li id=\"field_210_121\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gf_list_5col gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_121\"><label class='gfield_label gform-field-label'  >d) Will you provide the Recipient with ANY DATA related to the materials\/samples?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_210_121'>\n\t\t\t<li class='gchoice gchoice_210_121_0'>\n\t\t\t\t<input name='input_121' type='radio' value='Yes'  id='choice_210_121_0'    \/>\n\t\t\t\t<label for='choice_210_121_0' id='label_210_121_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_210_121_1'>\n\t\t\t\t<input name='input_121' type='radio' value='No'  id='choice_210_121_1'    \/>\n\t\t\t\t<label for='choice_210_121_1' id='label_210_121_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_100\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_100\"><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_210_109\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield_contains_required field_sublabel_above gfield--has-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_109\"><label class='gfield_label gform-field-label gfield_label_before_complex'  >9) Does the MATERIAL include any of the following?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_210_109'>(Check all that apply)<\/div><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_210_109'><li class='gchoice gchoice_210_109_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.1' type='checkbox'  value='a) Material and\/or agents developed or stored in the National Emerging Infectious Diseases Laboratory (NEIDL)'  id='choice_210_109_1'   aria-describedby=\"gfield_description_210_109\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_210_109_1' id='label_210_109_1' class='gform-field-label gform-field-label--type-inline'>a) Material and\/or agents developed or stored in the National Emerging Infectious Diseases Laboratory (NEIDL)<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_210_109_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.2' type='checkbox'  value='b) &lt;strong&gt;hazardous&lt;\/strong&gt; material per the &lt;a href=&quot;https:\/\/www.bu.edu\/research\/ethics-compliance\/safety\/biological-safety\/ibc\/&quot;&gt;Institutional BioSafety Committee (IBC)&lt;\/a&gt; or &lt;a href=&quot;https:\/\/www.ecfr.gov\/current\/title-49\/subtitle-B\/chapter-I\/subchapter-C\/part-172\/subpart-B&quot;&gt;Dept. of Transportation (DoT)&lt;\/a&gt;'  id='choice_210_109_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_210_109_2' id='label_210_109_2' class='gform-field-label gform-field-label--type-inline'>b) <strong>hazardous<\/strong> material per the <a href=\"https:\/\/www.bu.edu\/research\/ethics-compliance\/safety\/biological-safety\/ibc\/\">Institutional BioSafety Committee (IBC)<\/a> or <a href=\"https:\/\/www.ecfr.gov\/current\/title-49\/subtitle-B\/chapter-I\/subchapter-C\/part-172\/subpart-B\">Dept. of Transportation (DoT)<\/a><\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_210_109_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.3' type='checkbox'  value='c) &lt;strong&gt;dangerous&lt;\/strong&gt; goods per the &lt;a href=&quot;https:\/\/www.iata.org\/&quot;&gt;International Air Transport Association (IATA)&lt;\/a&gt;'  id='choice_210_109_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_210_109_3' id='label_210_109_3' class='gform-field-label gform-field-label--type-inline'>c) <strong>dangerous<\/strong> goods per the <a href=\"https:\/\/www.iata.org\/\">International Air Transport Association (IATA)<\/a><\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_210_109_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.4' type='checkbox'  value='d) &lt;strong&gt;novel&lt;\/strong&gt; chemical molecule not yet classified under the &lt;a href=&quot;https:\/\/www.epa.gov\/chemicals-under-tsca&quot;&gt;Toxic Substances Control Act&lt;\/a&gt;'  id='choice_210_109_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_210_109_4' id='label_210_109_4' class='gform-field-label gform-field-label--type-inline'>d) <strong>novel<\/strong> chemical molecule not yet classified under the <a href=\"https:\/\/www.epa.gov\/chemicals-under-tsca\">Toxic Substances Control Act<\/a><\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_210_109_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.5' type='checkbox'  value='e) &lt;strong&gt;compounds&lt;\/strong&gt; from the BU &lt;a href=&quot;https:\/\/www.bu.edu\/cmd\/&quot;&gt;Center for Molecular Discovery (CMD)&lt;\/a&gt;'  id='choice_210_109_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_210_109_5' id='label_210_109_5' class='gform-field-label gform-field-label--type-inline'>e) <strong>compounds<\/strong> from the BU <a href=\"https:\/\/www.bu.edu\/cmd\/\">Center for Molecular Discovery (CMD)<\/a><\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_210_109_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.6' type='checkbox'  value='f) materials from the &lt;a href=&quot;https:\/\/www.framinghamheartstudy.org\/fhs-for-researchers\/policies-and-procedures\/distribution-agreements-and-irb-approval\/&quot;&gt;Framingham Heart Study&lt;\/a&gt;'  id='choice_210_109_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_210_109_6' id='label_210_109_6' class='gform-field-label gform-field-label--type-inline'>f) materials from the <a href=\"https:\/\/www.framinghamheartstudy.org\/fhs-for-researchers\/policies-and-procedures\/distribution-agreements-and-irb-approval\/\">Framingham Heart Study<\/a><\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_210_109_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_109.7' type='checkbox'  value='g) None of the above'  id='choice_210_109_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_210_109_7' id='label_210_109_7' class='gform-field-label gform-field-label--type-inline'>g) None of the above<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_110\"  class=\"gfield gfield--type-section gsection field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_110\"><h2 class=\"gsection_title\"><\/h2><\/li><li id=\"field_210_119\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gf_list_5col gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_119\"><label class='gfield_label gform-field-label'  >10) Was the material developed outside your lab at BU\/BMC (even partially), or does it incorporate or derive from third party material?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_210_119'>\n\t\t\t<li class='gchoice gchoice_210_119_0'>\n\t\t\t\t<input name='input_119' type='radio' value='Yes'  id='choice_210_119_0'    \/>\n\t\t\t\t<label for='choice_210_119_0' id='label_210_119_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_210_119_1'>\n\t\t\t\t<input name='input_119' type='radio' value='No'  id='choice_210_119_1'    \/>\n\t\t\t\t<label for='choice_210_119_1' id='label_210_119_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_210_150\"  class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_150\"><label class='gfield_label gform-field-label' for='input_210_150' >a) Please provide (i) the name of third party or where material was developed, (ii) the third party material, and (iii) how it was used to derive the Material.)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_150' id='input_210_150' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_210_151\"  class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_151\"><label class='gfield_label gform-field-label' for='input_210_151' >b. Please describe any agreements that apply (MTA-in, SRA, CDA, PO, etc.) and attach files below if available.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_151' id='input_210_151' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_210_72\"  class=\"gfield gfield--type-fileupload field_sublabel_above gfield--no-description field_description_above gfield_visibility_visible\"  data-js-reload=\"field_210_72\"><label class='gfield_label gform-field-label' for='input_210_72' >c. 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