Addgene MTA Form

Brief Summary of MTA Addgene Request (required)

Department (required)

PI Name (required)

The UCSD PI responsible for this material and this transfer

PI Email (required)

Point of Contact Name (required)

Your name (if you are the PI, put "PI")

Point of Contact Email (required)

Your email (if you are the PI, put "PI)

Does your request include a biological material that contains a prohibited pathogen, toxin or select agent? (required)

See the ECCN 1C351 list to make this determination: https://blink.ucsd.edu/sponsor/exportcontrol/Export-Restricted-Biologicals.pdf If you answer yes to this question, please also contact Export Control at export@ucsd.edu

Addgene Order Number (required)

Please enter the 6-digit Addgene order number (not the catalog number)

Material/Plasmid Name(s) (required)

Identify the specific name of the material/plasmid. Please include a list of all plasmids on this order (this will ensure that all appropriate MTA(s) are completed.

Project Description/Statement of Work (required)

Provide a concise scientific description (SOW) of your use of the material.

Will the material be combined or used with other material obtained under a previous agreement? (required)

If Yes, please explain

What is the funding source and the Oracle Project number for the funds supporting the research using this Material? (required)

Ex. “NIH, Oracle Project# 1234567”. Note: This information is required to ensure the research is free from conflicting obligations – this number will NOT be charged.

Additional Comments/Notes

*Captcha has been added to this form as a precaution against spam, as we have received spam submissions recently. Thank you for your understanding!