Spreadsheet: 54e7d4ea-7924-4056-b461-11790a9d8a68
Sheet: Sheet1

Unnamed: 0 | Unnamed: 1 | Unnamed: 2 | Unnamed: 3 | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14
 |  |  |  |  |  |  | Sperm Cryopreservation Request Form
 |  |  |  |  |  |  | University of Maryland, Baltimore    School of Medicine Transgenic Core Laboratory   Howard Hall 581    706-0453
 |  |  |  |  |  | Request Date
 |  |  |  |  |  | PI Name |  |  |  |  | Campus Address
 |  |  |  |  |  | Greenebaum Cancer Center Member? |  |  |  |  | (Office)
 |  |  |  |  |  |  | YES | NO |  |  | (Lab)
 |  |  |  |  |  | Department
 |  |  |  |  |  | Phone |  |  |  |  | email
 |  |  |  |  |  | Lab Contact |  |  |  |  | email
 |  |  |  |  |  | Chartstring to be charged
 |  |  |  |  |  | Strain for Cryopreservation:
 |  |  |  |  |  | (include strain backgroud in description)
 |  |  |  |  |  | Name Designation of Strain:
 |  |  |  |  |  | Indicate Genetic Status of Strain: |  |  |  |  |  | HOMOZYGOUS |  | HETEROZYGOUS
 |  |  |  |  |  | Will Cryopreserved Sperm be Thawed Within 6 Months? |  |  |  |  |  | YES |  | NO
 |  |  |  |  |  | Animal Space Location: |  |  |  |  |  | ARF# |  | Exp. Date
 |  |  |  |  |  |  |  |  |  |  |  | Please include a copy of your protocol approval letter
 |  |  |  |  |  | Three Levels of Sperm Cryopreservation are Offered (all require 2 fertile males, 10-16 weeks of age):
 |  |  |  |  |  | Options: | 1. In-House reagents - In-House protocol |  |  |  |  | lower cost/lowest efficiency
 |  |  |  |  |  |  | 2. JAX reagents* - In-house protocol |  |  |  |  | medium cost/medium effieciency
 |  |  |  |  |  |  | 3. JAX reagents* - JAX protocol* |  |  |  |  | higher cost/highest efficiency
 |  |  |  |  |  | Pricing: | 1. In-House reagents - In-House protocol |  |  |  |  | $100; 10 straws/male; no guarantees
 |  |  |  |  |  |  | 2. JAX reagents - In-house protocol |  |  |  |  | $1400; 16+ straws; JAX QC guarantee plus storage
 |  |  |  |  |  |  | 3. JAX reagents - JAX protocol at JAX |  |  |  |  | $1800; 16+ straws; JAX QC guarantee plus storage
 |  |  |  |  |  | All sperm cryopreservation projects require (at additional cost) IVF for strain recovery. In-House (UMB) IVF is available for $300 (partial
 |  |  |  |  |  | guarantee) or $650 (nominal guarantee); the UMB storage fee is $30 per year per strain. Partial/Nominal guarantee of the UMB service is only
 |  |  |  |  |  | available when IVF testing is included in the cryopreservation package ($400/$750 total cryopresevation cost). Additional IVF charges apply
 |  |  |  |  |  | at the time of strain recovery. The second option above includeds labor, shipping and  JAX IVF QC as well as 3 years of storage fees. Recovery
 |  |  |  |  |  | for most strains is $1300 (SPFanimals are provided 9-12 weeks from request date). Storage fees for this option (beyond 3 years) are $175/year
 |  |  |  |  |  | per strain. The third option above does not include shipment to JAX where processing occurs with full QC inckluding IVF and 3 years of storage.
 |  |  |  |  |  | Recovery for most strains is $1300 (SPF animals are provided 9-12 weeks from request date) with an additional $650 for QC of live born pups..
 |  |  |  |  | Option 3 is arranged through [NAME](www.jax.org).
 |  |  |  |  | * [NAME] laboratories (JAX) Sperm [NAME]3550 for 3 strain kit  -  UMB can conserve costs when 3 strains are cryopreserved at one time (Opt 2)
 |  |  |  |  |  |  |  |  |  |  | ALLCRYOPRESERVATION PROJECTS REQUIRE CONSULTATION
 |  |  |  |  |  |  |  |  |  |  | WITH TRANSGENIC LAB STAFF PRIOR TO INITIATION
 |  |  |  |  |  | PI Signature: |  |  |  |  |  |  |  | Date
 |  |  |  |  |  | Transgenic Lab Approval: |  |  |  |  |  |  |  | Date
 |  |  |  |  |  | Return this completed form to: Transgenic Core Facility, [NAME] (FAX [PHONE])
 |  |  |  |  |  | This form and all requested information and supporting data must be received prior to project initiation