DONOR NAME (P.I.): _____________________________________________
DEPARTMENT: ________________________________
TELEPHONE EXTENSION: _______________________
IACUC APPROVED PROJECT NUMBER: _____________
DATE OF REQUEST: ____________________________
DATE TRANSFER DESIRED: _____________________
SPECIES/BREED: ____________________________
QUANTITY: _______ SEX: _______ AGE: __________
WHAT EXPERIMENTAL PROCEDURE(S) HAVE THESE ANIMALS EXPERIENCED?
SIGNATURE OF DONOR: ____________________________
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RECIPIENT FACULTY NAME (P.I.): ______________________________________________
DEPARTMENT: _________________________________
TELEPHONE EXTENSION: ________________________
IACUC APPROVED PROJECT NUMBER: ______________
NUMBER OF ANIMALS
APPROVED FOR THE PROJECT: ______________
SPECIES/BREED: _______________________
TOTAL OF ANIMALS PREVIOUSLY PURCHASED AND TRANSFERRED TO THE PROJECT:
____________
WHAT EXPERIMENTAL PROCEDURE(S) WILL THESE ANIMALS EXPERIENCE?
SIGNATURE OF RECIPIENT: ____________________________
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