>     SLA M-NNNN-NNN

**Simple Letter Agreement for the Transfer of Materials    **

In response to RECIPIENT's request for the MATERIAL, 

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  ***list_materials_here***

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, the PROVIDER asks that the RECIPIENT and the RECIPIENT SCIENTIST agree
to the following before the RECIPIENT receives the MATERIAL: 

1\. The above MATERIAL is the property of the PROVIDER and is made
available as a service to the research community.

2\. **THIS MATERIAL IS NOT FOR USE IN HUMAN SUBJECTS.**

3\. The MATERIAL will be used for teaching or not-for-profit research
purposes only.

4\. The MATERIAL will not be further distributed to others without the
PROVIDER\'s written consent. The RECIPIENT shall refer any request for
the MATERIAL to the PROVIDER. To the extent supplies are available, the
PROVIDER or the PROVIDER SCIENTIST agree to make the MATERIAL available,
under a separate Simple Letter Agreement to other scientists for
teaching or not-for-profit research purposes only.

5\. The RECIPIENT agrees to acknowledge the source of the MATERIAL in
any publications reporting use of it.

6\. Any MATERIAL delivered pursuant to this Agreement is understood to
be experimental in nature and may have hazardous properties. THE
PROVIDER MAKES NO REPRESENTATIONS AND EXTENDS NO WARRANTIES OF ANY KIND,
EITHER EXPRESSED OR IMPLIED. THERE ARE NO EXPRESS OR IMPLIED WARRANTIES
OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE, OR THAT THE USE
OF THE MATERIAL WILL NOT INFRINGE ANY PATENT, COPYRIGHT, TRADEMARK, OR
OTHER PROPRIETARY RIGHTS. Unless prohibited by law, RECIPIENT assumes
all liability for claims for damages against it by third parties which
may arise from the use, storage or disposal of the MATERIAL except that,
to the extent permitted by law, the PROVIDER shall be liable to the
RECIPIENT when the damage is caused by the gross negligence or willful
misconduct of the PROVIDER.

7\. The RECIPIENT agrees to use the MATERIAL in compliance with all
applicable statutes and regulations.

8\. The MATERIAL is provided at no cost, or with an optional transmittal
fee solely to reimburse the PROVIDER for its preparation and
distribution costs. If a fee is requested, the amount will be indicated
here: [none]{.underline}.

The PROVIDER, RECIPIENT and RECIPIENT SCIENTIST must sign both copies of
this letter and return one signed copy to the PROVIDER. The PROVIDER
will then send the MATERIAL.

+--------------+----------+---------------------+---------------------+
| **[PROVIDER  |          |                     |                     |
| INFORMATION  |          |                     |                     |
| and          |          |                     |                     |
| AUTHORIZED   |          |                     |                     |
| SIGNATURE]   |          |                     |                     |
| {.underline} |          |                     |                     |
|     provider |          |                     |                     |
|    **        |          |                     |                     |
+--------------+----------+---------------------+---------------------+
| PROVIDER     | > Dr.    | > ***First_Name***  | > ***Last_Name***   |
| SCIENTIST:   |          |                     | >                   |
+--------------+----------+---------------------+---------------------+
| PROVIDER     | National |                     |                     |
| O            | I        |                     |                     |
| rganization: | nstitute |                     |                     |
|              | of       |                     |                     |
|              | Dental   |                     |                     |
|              | and      |                     |                     |
|              | Cran     |                     |                     |
|              | iofacial |                     |                     |
|              | Research |                     |                     |
|              | (        |                     |                     |
|              | "NIDCR") |                     |                     |
+--------------+----------+---------------------+---------------------+
| Address:     | BLDG 10  |                     |                     |
|              | RM       |                     |                     |
|              | 1N103,   |                     |                     |
|              | 10       |                     |                     |
|              | CENTER   |                     |                     |
|              | DR MSC   |                     |                     |
|              | 1197,    |                     |                     |
|              | BETHESDA |                     |                     |
|              | MD       |                     |                     |
|              | 20       |                     |                     |
|              | 892-1197 |                     |                     |
|              | USA      |                     |                     |
|              |          |                     |                     |
+--------------+----------+---------------------+---------------------+
| Name of      | David W. |                     |                     |
| Authorized   | Bradley  |                     |                     |
| Official:    | Ph.D.    |                     |                     |
+--------------+----------+---------------------+---------------------+
| Title of     | Te       |                     |                     |
| Authorized   | chnology |                     |                     |
| Official:    | Dev      |                     |                     |
|              | elopment |                     |                     |
|              | Coo      |                     |                     |
|              | rdinator |                     |                     |
|              |          |                     |                     |
+--------------+----------+---------------------+---------------------+

Certification of Authorized Official: This Simple Letter Agreement has /
has not \[check one\] been modified. If modified,

the modifications are attached.  

  ------------------------------------------- -- -------------------------
                                                 

  Signature of Authorized Official               Date
  ------------------------------------------- -- -------------------------

<table>
<colgroup>
<col style="width: 0%" />
<col style="width: 20%" />
<col style="width: 16%" />
<col style="width: 3%" />
<col style="width: 9%" />
<col style="width: 2%" />
<col style="width: 7%" />
<col style="width: 8%" />
<col style="width: 11%" />
<col style="width: 1%" />
<col style="width: 17%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="11"><strong><u>RECIPIENT INFORMATION and AUTHORIZED
SIGNATURE</u></strong>     recipient    </td>
</tr>
<tr class="even">
<td colspan="2">RECIPIENT SCIENTIST:</td>
<td><blockquote>
<p><em><strong>Dr. / Mr. / Ms.</strong></em></p>
</blockquote></td>
<td colspan="5"><blockquote>
<p><em><strong>First_Name</strong></em></p>
</blockquote></td>
<td colspan="3"><blockquote>
<p><em><strong>Last_Name</strong></em>    </p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="2">RECIPIENT Organization:</td>
<td colspan="9"><blockquote>
<p><em><strong>Legal_Name_of_your_Institution_or_University</strong></em></p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="2">Address: </td>
<td colspan="9"><blockquote>
<p><em><strong>Location_of_Official_Office_for_Legal_Notification</strong></em></p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="9"><blockquote>
<p><em><strong>Official_Street_Address</strong></em></p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="2"><blockquote>
<p><em><strong>city</strong></em></p>
</blockquote></td>
<td colspan="3"><blockquote>
<p><em><strong>state_or_province</strong></em></p>
</blockquote></td>
<td colspan="2"><blockquote>
<p><em><strong>zip_code</strong></em></p>
</blockquote></td>
<td colspan="2"><blockquote>
<p><em><strong>country</strong></em>      </p>
</blockquote></td>
</tr>
<tr class="odd">
<td colspan="2">Name of Authorized Official:</td>
<td><blockquote>
<p><em><strong>Dr./ Mr./ Ms.</strong></em></p>
</blockquote></td>
<td colspan="5"><blockquote>
<p><em><strong>First_Name</strong></em></p>
</blockquote></td>
<td colspan="3"><blockquote>
<p><em><strong>Last_Name</strong></em>  </p>
</blockquote></td>
</tr>
<tr class="even">
<td colspan="2">Title of Authorized Official:</td>
<td colspan="9"><blockquote>
<p><em><strong>Job_Title_of_Authorized_Official</strong></em>      </p>
</blockquote></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="4"></td>
<td></td>
<td colspan="4"></td>
<td></td>
</tr>
<tr class="even">
<td></td>
<td colspan="4">Signature of Authorized Official</td>
<td></td>
<td colspan="4">Date</td>
<td></td>
</tr>
</tbody>
</table>

Certification of RECIPIENT SCIENTIST: I have read and understood the
conditions outlined in this Agreement and I agree to abide

by them in the receipt and use of the MATERIAL.

  ------------------------------------------- -- -------------------------
                                                 

  RECIPIENT SCIENTIST                            Date
  ------------------------------------------- -- -------------------------

**Addendum**

The shipping and email address for RECIPIENT SCIENTIST are:

  --------------------------------------------- ------------------------- ---------------- -------------------------------------------------- -----------------------
  *Address (Line 1):*                                                                                                                         

  ***Department,\_Laboratory,\_or_Building***                                                                                                 

  *(Line 2)*                                                                                                                                  

  ***Street_Address_and_Floor/Room***                                                                                                         

  *City*                                        *State or Province*       *Zip Code*                                                          *Country*

  ***City***                                    ***State_or_Province***   ***Zip_Code***                                                      ***Country***

  *Email Address: *                                                                                                                           

  ***email_address_for_investigator***                                                                                                        

  *telephone*                                                                              *Shipping Vendor & Account No. (optional)*         

  ***Telephone_Number***                                                                   ***Shipper\_(e.g.\_FEDEX)\_and_Account_Number***   
  --------------------------------------------- ------------------------- ---------------- -------------------------------------------------- -----------------------

The email address of the RECIPIENT's Authorized Official is:  

  -----------------------------------------------------------------------
  *Email Address: *

  ***Email_Address_for_Authorized_Official***
  -----------------------------------------------------------------------

>     

+-------------------------------------+--------------------------------+
| RECIPIENT has no delivery           | to the RECIPIENT SCIENTIST,    |
| preference                          |                                |
|                                     | to the RECIPIENT's Authorized  |
| or prefers to have \[check if       | Official                       |
| applicable\]                        |                                |
|                                     | to the RECIPIENT CONTACT with  |
| an original, fully executed         | the name, mailing              |
| agreement sent by mail              |                                |
|                                     | address, and email address,    |
| a copy of the fully executed        | shown below:                   |
| agreement sent by email             |                                |
+-------------------------------------+--------------------------------+

         

  ----------------------------------------------------- ----------------------------- ------------------------- ---------------------------- -----------------------
  *(Dr. Ms. Mr.)*                                       *First Name*                                            *Last Name*                  

  ***Dr. / Ms. / Mr.***                                 ***Contact\'s_First_Name***                             ***Contact\'s_Last_Name***   

  *Job Title** *                                                                                                                             

  ***Job_Title_of_Contact_Person***                                                                                                          

  *Address (Line 1) *                                                                                                                        

  ***Contact\'s_Office,\_Building,\_or_Room_Number***                                                                                        

  *(Line 2)*                                                                                                                                 

  ***Contact\'s_Street_Address***                                                                                                            

  *City*                                                                              *State or Province*       *Zip Code*                   *Country*

  ***City***                                                                          ***State_or_Province***   ***Zip_Code***               ***Country***

  *Email Address*                                                                                                                            

  ***Contact\'s_Email_Address***                                                                                                             
  ----------------------------------------------------- ----------------------------- ------------------------- ---------------------------- -----------------------

Provider requests inquires and partly executed agreements be sent to
PROVIDER CONTACT:        

Ms. Stephanie Bonhomme 

Technology Development Specialist  

BLDG 10 RM 1N103

10 CENTER DR MSC 1197

BETHESDA MD 20892-1197 UNITED STATES  

bonhommes@nidcr.nih.gov  (to communicate after obtaining MTA ID#)

NIDCReMTA@mail.nih.gov (to obtain MTA ID#)        

**Instructions** (for Scientists Requesting Materials from NIDCR)

This **Simple Letter Agreement (SLA)** is for transferring materials
that are not obtained from humans. The materials are for research use
only and are not to be used in humans. The National Institutes of Health
(NIH) encourages use of this form whenever possible.

1.  Replace the **BLUE TEXT** in this sample agreement with your
    information. If the information does not apply to you, leave the
    field blank.

2.  Define \"**MATERIAL**\" at the top of the form. Be specific. A
    general description such as \"plasmids\" or \"antiserum\" is not
    acceptable. If you are uncertain which materials to request, it is
    important to contact the NIDCR investigator for clarification.

3.  Indicate the name of the "**PROVIDER SCIENTIST**," that is the
    Principal Investigator at NIDCR who will be providing the MATERIAL.
    A directory of NIDCR staff is available here:
    <http://www.nidcr.nih.gov/AboutNIDCR/StaffDirectory>.

4.  Fill in the first and last name of the "**RECIPIENT SCIENTIST**" in
    the section below "RECIPIENT INFORMATION and AUTHORIZED SIGNATURE."

5.  Fill in the **[legal name]{.underline}** for your university or
    institution next to "**RECIPIENT Organization**." This is not your
    lab, nor your department. Do not include your department,
    laboratory, or faculty name.

6.  Provide an official address for your organization. We will use this
    address to return an original copy of the fully executed agreement
    if one is requested. (Fully executed means that the agreement was
    signed by authorized officials at each institution.)

7.  Determine who the **Authorized Official** is from your organization.
    This person is an official authorized to sign Material Transfer
    Agreements on behalf of your Institution or University. Usually he
    or she is the head of your technology transfer office, intellectual
    property office, a Dean of Research, or an administrative official.
    The Authorized Official does not necessarily have an academic
    appointment. **[Fill in the name and job title of the Authorized
    Official.]{.underline}** If you are not certain what the job title
    is, ask your Authorized Official and they will provide this
    information.

8.  Fill in your shipping address on the top of the second page of the
    agreement. Next, fill in the email address of the authorized
    official.

9.  If your institution requires an original copy of the fully executed
    agreement, check the appropriate box on the second page. If you have
    a preference, indicate to whom the agreement should be delivered:
    the RECIPIENT SCIENTIST, the RECIPIENT's Authorized Official, or the
    RECIPIENT CONTACT. Type in the name, address, and email address of
    the contact person if this is different than the Authorized Official
    or RECIPEINT SCIENTIST.

10. **[Send the electronic copy of the agreement via
    email]{.underline}** to **[NIDCReMTA@mail.nih.gov]{.underline}**. We
    will generate an Identification Number (MTA ID#) for the agreement
    which will help speed processing. We will also review the agreement
    for errors before you mail the original.

11. **[Wait for us to review the agreement and reply with a MTA ID#.
    Print out two copies of the agreement with the MTA ID# on the top
    right corner]{.underline}.** The instruction page is not part of the
    agreement and does not need to be included. (Note: if your
    institution does not require a hard copy of the original executed
    agreement, a single copy of the agreement may be sent to our office.
    NIDCR requires original signatures for the Authorized Official and
    RECIPIENT SCIENTIST. The agreement does not have to be printed in
    color.)

12. Have the RECIPIENT SCIENTIST **[sign and date]{.underline}** both
    copies of the agreement above \"RECIPIENT SCIENTIST\" **[next to the
    RED ARROW]{.underline}**.

13. Ask the Authorized Official to **[sign and date]{.underline}** above
    \"Signature of Authorized Official" **[next to the GREEN
    ARROW]{.underline}**. If you are the RECIPIENT SCIENTIST and you
    intend to sign the form yourself as the Authorized Official, you
    must confirm that you are authorized to execute Material Transfer
    Agreements. If you falsely represent yourself as the authorized
    official, there may be negative personal and/or professional
    repercussions.

14. Mail both copies of the agreement to the PROVIDER CONTACT. For
    fastest delivery, we suggest using a courier service or certified
    mail/return receipt.

15. ***[Please include the MTA ID# on the subject line of any
    correspondence]{.underline}***.

**If this agreement is filled out completely and accurately we can
process your request quickly. If there are mistakes or if contact
information is wrong or incomplete, there can be significant delays.
Thank you for your help in providing the information we need so delays
can be minimized**.