Mouse sperm cryopreservation and validation order form Mouse sperm cryopreservation and validation order form For sperm cryopreservation of a mouse line, 2 sexually mature males will be needed. They should be older than 12 weeks and younger than 5 months and of proven fertility (individually caged breeders with at least 2 litters). Sperm Cryo yields 16 straws of frozen sperm from 1 mouse line, with each straw holding enough sperm to fertilize the oocytes from up to 12 females. As an additional service, the facility will thaw a straw of sperm along with each frozen line to perform IVF. Contact Information Principal investigator (PI) * Principal investigator (PI) First First Last Last PI email PI phone Contact person Contact person First First Last Last Contact person email Contact person phone Address Project Information Mouse Strain Genetic background Mouse protocol # USC client: Mouse sperm cryopreservation from 2 procedure compatible males Other academic institution client: Mouse sperm cryopreservation from 2 procedure compatible males Industry client: Mouse sperm cryopreservation from 2 procedure compatible males Usc client: In vitro fertilization validation of cryopreserved sperm – 50 donor eggs (B6D2F1 strain) (additional cost) Other academic institution client: In vitro fertilization validation of cryopreserved sperm – 50 donor eggs (B6D2F1 strain) (additional cost) Industry client: Usc client: In vitro fertilization validation of cryopreserved sperm – 50 donor eggs (B6D2F1 strain) (additional cost) Additional project information helpful for performing the job Billing Information PPGG # USC: Please provide an account number. Non-USC, including CHLA: Please provide a PO. Cost center Are you a non-USC client (i.e., other academic institution, industry)? Yes No Date * PI signature * After this form is submitted, the Genome Modification Facility will assess the job, provide a job number, schedule a date for the procedure, and notify the PI and the contact person. The outcomes for all procedures are dependent on a variety of factors, many of which are beyond the control of the facility. Whereas the facility has had excellent outcomes over many years for all procedures offered, outcomes of individual projects cannot be guaranteed. The investigator agrees to pay for the services, independent of the outcome. If you are human, leave this field blank. This form is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Submit
