The Pennsylvania State University
Animal Resource Program 	
Import  #      
		Request for Animal Importation 
From Non-Approved Source
Send completed form to: arp@psu.edu	

Penn State Investigator Complete Page 1:	
	
Penn State Investigator Information:            	
Name of PSU Investigator:	     	
Name of Lab Contact:	     	
Phone  Number:	     	
Email:	     	
Protocol number which animals will be assigned:	     	
Date:	     	

Animal Importation Information:	
Species:	     	
Number of Animals and Gender:	      Male	      Female	
Immune Status:	 Normal	 Immunocompromised	
Require Autoclaved Caging:	 Yes	 No	

Please provide as much information as possible regarding characteristics of this strain including any special handling requirements:  	
     	

Strain and Genotype: Investigators who want to import mutant or transgenic animals not listed on their current IACUC protocol must submit a modification form and obtain IACUC approval before ordering/importing such animals. Please see the ORP website for more information.	
     	     	
     	     	
     	     	
     	     	

Source:	
Name of Investigator (providing the animals):	     	
Name of Institute:	     	
Shipping Contact from Source:	     	
Shipping Contact Email:	     	
Shipping Contact Phone: 	     	
Animal Resource Program Complete Page 2:	
	
ARP Importation Check off:	
 Completed Import Request Form                   
 Health Surveillance Report Received             
 Room Assignment                                                     
 Shipping Address Provided                            
 Importation Approval provided to Shipper      	

Animal Information:	
Species:	     	
Number of Animals and Gender:	      Male	      Female	
Sending Cull Mouse:	 Yes	 No	

Shipping Courier: