**[MIF ANIMAL TRANSFER REQUEST FORM]{.underline}**

All transfers of animals from an NCI animal facility to the Mouse
Imaging Facility (MIF) are arranged by the NCI facility management. This
form is available in the facility manager's office or via e-mail and
must be **submitted to the facility manager 4 working days prior to the
requested transfer date**. Animals will be packed in appropriate
shipping containers and transported to the MIF by the date and time
requested. This **form can be submitted by fax or by e-mail** to the
facility where the animals are currently located.

+-----------------------------------------------------------------------+
| **Request transfer by Date:**                                         |
|                                                                       |
| **Time:**                                                             |
+-----------------------------------------------------------------------+

+--------------------------+---------------------+---------------------+
| Requester Name:          | PI:                 | ASP:                |
+--------------------------+---------------------+---------------------+
| Phone #:                 | Building/ room #:   | E-mail:             |
+--------------------------+---------------------+---------------------+
| **Animals are currently  |                     |                     |
| housed in:**             |                     |                     |
+--------------------------+---------------------+---------------------+
| Building #:              | Room \# :           | Rack #:             |
+--------------------------+---------------------+---------------------+
| **Animal Information:**  |                     |                     |
+--------------------------+---------------------+---------------------+
| Mouse or Rat (circle     | Strain/genotype:    | DOB:                |
| one)                     |                     |                     |
+--------------------------+---------------------+---------------------+
| \# of cages:             | \# of animals:      | Ear tag #s /other   |
|                          |                     | ID:                 |
+--------------------------+---------------------+---------------------+
| Describe any procedures  |                     |                     |
| done to the animals i.e. |                     |                     |
| surgery, inoculations,   |                     |                     |
| tumor implantation:      |                     |                     |
|                          |                     |                     |
+--------------------------+---------------------+---------------------+

**Please check one:**

\_\_\_\_\_ These animals will be imaged at the MIF and euthanized the
same day.

\_\_\_\_\_\_ These animals will be imaged at the MIF and housed at the
MIF for \_\_\_\_\_ days.

\_\_\_\_\_\_ These animals will be imaged at the MIF and then moved to
building 14D South for holding.

(The investigator must make **arrangements with Lindsey Briglio
301-496-5246 for 14D South housing)**

\_\_\_\_\_ Other, please describe:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

-   The **investigator must identify the cages** of animals to be
    transferred. Green shipping tags should be placed on each cage.
    Write MIF and the date to be transferred on the tag. Please place
    tags **at least 2 working days in advance** of the requested
    transfer date.

-   The facility manager will notify the recipient(s) at the MIF and 14D
    South.

-   On the day of transportation **facility management will prepare the
    shipping containers, pack the animals and transfer the animals to
    the MIF** (Bldg 10 /B1D200).

[Health certification]{.underline}:

To the best of my knowledge these animals meet the health status
requirements for the MIF and 14D South. Current health surveillance
reports are available at
<http://web.ncifcrf.gov/rtp/LASP/intra/ahdl/reports.asp>

These mice are not currently being observed or treated for any problems,
except as noted below:

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Veterinarian or Vet Associate signature Date