Chimera Service Request (Bold Fields required)
PI Last Name:
Account:
IACUC Protocol Number:
IBC Protocol Number:
What is the BioSafety Level?
BSL1
BSL2
BSL3
(Most work is BSL1)
Name of Cell Line:
Parental Cell Line Name:
Genetic Background of Cell Line
129 $2750
C57BL/6 $4150
other $4150
Reference/Description for Parental Line:
Passage Number of Line to be Injected:
Has the Cell Line been Screened for Aneupoidy?
Yes
No
If
yes
, give outcome below
Has the Cell Line Been Screened for Mycoplasma?
Yes
No
If
yes
, give outcome below
Is a Phenotype Expected in the Chimera?
Yes
No
If
yes
, give details below
Has the Parental Line Gone Germline at CWRU?
Yes
No
Give details below
Recombination verified with 5' external probe?
Yes
No
N/A
Recombination verified with 3' external probe?
Yes
No
N/A
Recombination verified with internal probe?
Yes
No
N/A
What is the source of this cell line? Was it targeted/transfected by our facility? If so, what construct? Is it from a genetrap resource?