------------------- --------------------------- --------------------------------
  [Type               [Type Investigators Name    [Type Investigator\'s Title
  Date]{.underline}   Here]{.underline}           Here]{.underline}

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

  ---------------------------------- ---------------------------------------------------------------------------- --------------------------------
  [\_\_\_\_\_\_\_\_\_]{.underline}   [\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}   [Type Authorized Signator\'s
                                                                                                                  Title Here]{.underline}

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

  ---------------------------------- ---------------------------------------------------------------------------- ------------------------------------------------------------------------------------------
  [\_\_\_\_\_\_\_\_\_]{.underline}   [\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}   [\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}

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

  ---------------------------------- ---------------------------------------------------------------------------- --------------------------------
  [\_\_\_\_\_\_\_\_\_]{.underline}   [\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline}   [Technology Development
                                                                                                                  Coordinator]{.underline}

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

**Instructions** (this page is not part of the agreement)

If you are requesting materials from an investigator employed by the
NIDCR, please follow these instructions:

1.  Determine if this is the appropriate form by contacting the
    investigator or reading our web pages:
    http://www.nidcr.nih.gov/Research/Intramural/TechTransfer/IntramuralTechnologyTransferMTA.htm

2.  Download your preferred format from our web page.

3.  Fill in the \"**Provider**,\" in this case the NIDCR.

4.  Fill in the \"**Recipient**.\" The \"**Recipient**\" is your
    employing institution, it is not your lab or department.

5.  Define the \"**Research Material**.\" Be specific. A general
    description such as \"plasmids\" or \"anitsera\" is not acceptable.
    If you are uncertain which materials to request, it is important to
    contact the NIDCR investigator for clarification.

6.  In most cases, Research Materials provided by the NIDCR are not
    obtained from human subjects and the \"Not Applicable\" box is
    checked in paragraph 2(a). If the Research Materials are clinical
    samples, check \"Yes\" and contact the investigator for the
    Assurance Number.

7.  Write a \"**Research Project**\" in the space provided below
    paragraph 3 or provide an attachment as indicated. A well defined
    Research Project will enable us to confirm the materials are
    appropriate for the intended use. This is also a courtesy to the
    providing scientists, who have spent time and effort in creating and
    characterizing the Research Materials. If your research involves the
    use of human subjects, please provide an Assurance Number or letter
    from an appropriate committee certifying that the research is
    performed according to 45 CFR Part 46, \"Protection of Human
    Subjects.\"

8.  An electronic version of the file may be emailed to our office
    (<bradleyda@nidcr.nih.gov>), if you wish us to review the document
    before it is signed and mailed.

9.  **Print out two copies of the agreement.**

10. Sign and date both copies of the agreement above \"Recipient\'s
    Investigator and Title.\" Scans of signatures, which are sometimes
    cut and pasted into the document, are not accepted.

11. Have an authorized official from your institution sign and date
    above \"Authorized Signature for Recipient and Title.\" An
    authorized official is the individual at your institution who can
    execute Material Transfer Agreements. It is usually the head of a
    technology transfer department or the Dean of Research. It is not
    the investigator requesting the materials.

12. Include the mailing address for the location to which the MTA will
    be sent. This is usually the technology transfer office. It is
    helpful to include your email address and the mailing address for
    the materials in a cover letter, but this is not required.
    Alternatively, communicate directly with the investigator to arrange
    for transfer of the materials.

13. Mail both copies of the agreement to the investigator and ask them
    to forward it to our office (see below). We will review the
    agreement, sign both copies, and return one fully executed copy back
    to your institution.

Technology Development Coordinator

NIDCR Intramural Technology Transfer Office\
BUILDING 10 RM 1N103

10 CENTER DR MSC 1197\
BETHESDA MD 20892-1197\
\
If you have any questions or need help in completing the form, we are
happy to assist you.