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 |  |  |  |  |  |  | Construct Design 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
 |  |  |  |  |  | PRONUCLEAR CONSTRUCT: |  |  | Please attach a diagram of desired gene construct
 |  |  |  |  |  | Gene of interest (text file containing cDNA sequence is required):
 |  |  |  |  |  | Promoter, desired expression pattern (denote source of promoter):
 |  |  |  |  |  | Vector:
 |  |  |  |  |  | Controlling elements required (specify):
 |  |  |  |  |  | Desired mouse strain:
 |  |  |  |  |  | TARGETED CONSTRUCT: |  |  | Specify mouse strain of all source DNA (BAC, plasmids, fragments, etc.)
 |  |  |  |  |  |  | Please attach a diagram of the entire target gene with specific target area(s) indicated
 |  |  |  |  |  | Gene of interest (source of gDNA sequence should be identified):
 |  |  |  |  |  | Region of knockout/knockin (exon/intron region):
 |  |  |  |  |  | Positive selection cassette:
 |  |  |  |  |  | Negative selection cassette:
 |  |  |  |  |  | Recombinase recognition site(s):
 |  |  |  |  |  | Controlling elements:
 |  |  |  |  |  | Other considerations:
 |  |  |  |  |  | NOTE: | Indicate above either PRONUCLEAR or TARGETED construct. Fill in as much information as is known. The
 |  |  |  |  |  |  | exact details of constuct design will be discussed separately. A non-refundable charge of $1000 will apply
 |  |  |  |  |  |  | to initiate all construction projects. Additional charges will be made on a scheduled basis as the project
 |  |  |  |  |  |  | proceeds. Each charge session will be discussed with the PI or Lab Contact prior to processing any new
 |  |  |  |  |  |  | charges. Email confirmation of charge acceptance will be required for any project to continue, failure to
 |  |  |  |  |  |  | accept new charges will result in a pause in project progress or termination of the construction project.
 |  |  |  |  |  |  | Generally, pronuclear construct cost will be less than $5000 and targeted construct costs less than $12,000.
 |  |  |  |  |  |  | The Transgenic Lab cannot gurantee success of construction projects due to elements beyond our control.
 |  |  |  |  |  |  |  |  |  |  | ALL CONSTRUCTION PROJECTS REQUIRE CONSULTATION WITH
 |  |  |  |  |  |  |  |  |  |  | TRANSGENIC CORE 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