Transgenic Core Facility Order Form

Date _________________

Name of Person Conducting Experiment _____________________________________

E-mail address _______________________________________ Phone ____________

Principal Investigator’s Name ______________________________________________

Lab address and phone____________________________________________________

Designate a name for your construct (6-character maximum) _____________________

(this will be for Animal Care's use as well)

IACUC Protocol Number: ____________________ Date Approved: ______________

Do you have recombinant DNA approval? ÿ Yes ÿ No

(attach copy of approval to this form)

Construct plasmid DNA concentration____________________

Restriction enzyme(s) to use for transgene isolation ______________________________

Size of transgene______________________ Size of remaining vector _______________

Other Required Items:

Attach Schematic Map of the Transgene Showing all Recombinant Components (i.e. promoters, vectors, cDNAs, introns, polyA sites). Highlight any viral or pathogenic sequences.

Attach photograph of restriction digestion suggested above. Circle the Transgene band.

Principal Investigator Signature ______________________________________________
Primer Information

Date ________________

Name _________________________________________________________________

Lab ___________________________________________________________________

Lab address and

phone __________________________________________________________________

Primer #1: name _____________ length ____________ concentration_________________

Primer #2: name _____________ length ____________ concentration_________________

Primer #3 (if needed):

name _____________ length ____________ concentration_________________

Primer #4 (if needed):

name _____________ length ____________ concentration_________________

Optimal annealing temperature (if known) ____________

Product size ______________

Attach photograph of sample PCR.