Materials Transfer Request Form


Section One (Incoming Material Transfers)

Primary Researcher who will use the material, if not the Principal Investigator:

Research Contact Information:

Legal/Administrative Contact:

What is the material you are requesting? (include citation or website if applicable):

How long do you plan to retain and/or use the material? (maximum of 10 years):

List all current sources of funding for your research with the material (i.e. Sponsor name and Account number; if "none", so state):

For the purpose of research compliance review, check all of the following which apply.

IRB or IACUC Protocol Number, if applicable:

Do you have a financial interest in the Provider Organization?


Check for yes or no for each question

Are you aware of alternative sources, or do you know if this material is commercially available?


Will the materials be used in conjunction with any other materials received from a third party?


Are the materials relevant to any previous or pending disclosures of inventions?


Is this research/material controlled by Export Administration Regulations or International Traffic in Arms Regulations?


(regarding question) If yes, do you have foreign persons working in your lab (not just on this project)?


Briefly describe how the materials will be used.