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Dear Submitting Investigator,

Please use the following form to provide general information on your mouse strain you would like to send for phenotyping analysis by the German Mouse Clinic. This information is used to evaluate your submitted request and to summarize all important information about the mouse strain/mutation for a most effective phenotypic analysis. Therefore, it is important that you give us as much information as possible.

Please answer all questions and use "unknown", "not applicable", or "none" as necessary and do not enter information for more than one strain in each form.

In case we have multiple requests for a certain time slot your request will be evaluated by the project committee of the NGFN.

Click once the "Submit" button at the end of this form to submit your information to the German Mouse Clinic.

* required

Please answer all questions and use "unknown", "not applicable", or "none" as necessary and do not enter information for more than one strain in each form.
In case of problems, please contact us under the following email address: lengger@helmholtz-muenchen.de

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Sender
Your title:
Your first name :*		Your last name:*
Your email:*		Your phone (office):*
Your phone (mobile):		Your fax:

Your function is/are:

Post-Doc

Head of laboratory

Head of the institution

Head of institute
Your title:
Your first name:*		Your last name:*
Your email:*		Your phone (office):*
Your phone (mobile):		Your fax:

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Are you the contact person?*

Yes

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Are you a member of German National Genome Research Network (NGFN)?

Yes

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Institution
Institution:*
Department:*		Address (Street):*
Postcode:*		Town:*
County/State:		Country:*
Your homepage URL:

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I. What kind of mice do you want to send for phenotypic analysis?

1.1 Affected gene
Gene name (official MGI gene name):
Gene id (preferred: Ensembl):
Source database:

1.2 Type of mutation: *

*2. Name of the Mutant Mouse Line (MML):

*3. Genetic background:
On what genetic background was this mutant generated?

*4. How do you maintain your MML?

Only backcross

Only inbreeding

Other (e.g. >2 strains involved)

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5. Classification of your mutant line according to the German Genetic Engineering Act (Gentechnikgesetz - GenTG)

Please read the following definitions carefully:

Gen Section 3 - Definitions

Paragraph 3: Genetically modified organism means any organism the genetic material of which has been altered in a way that does not occur naturally
by mating or natural recombination. Techniques of altering the genetic material within these terms shall be, in particular:

recombinant DNA techniques using vector systems
techniques involving the direct introduction into an organism of hereditary material prepared outside the organism, including micro-injection, macro-injection and microencapsulation
cell fusion or hybridisation techniques whereby live cells with new combinations of genetic material are formed through methods that do not occur naturally.

The following shall not be considered techniques of altering genetic material:

in vitro fertilisation
conjugation, transduction, transformation or any other natural process
polyploidy induction, unless they involve the use of genetically modified organisms as donors or recipients or the use of recombinant DNA molecules.

Neither shall the following be considered techniques of altering genetic material

mutagenesis.

Please indicate that you have read and understood the above definitions*

Yes

Is your mutant mouse line considered genetically modified pursuant to the German Genetic Engineering Act (Gentechnikgesetz - GenTG)?*

Yes

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6. Mutant phenotype

Please provide a description of the major abnormalities (max. 1000 characters):*

Which kind of animals do you want to have analyzed?*

Homozygotes

Heterozygotes

If they change their physical condition, until what age or from what starting age would it be interesting to analyze them?

7. Special housing or care requirements

Do you anticipate any problems concerning the phenotyping procedure for the animals?

Do the animals need special feeding?*

Yes

Do the animals show aggressive behaviour?*

Only males

Both sexes

Are the animals susceptible to narcosis?*

Yes

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8. Scientific interest

Please cite three relevant literature references below (max. 500 characters):

Does/might this MML model a human condition? If yes, for which human condition could this MML be used as a model?

Yes

Unknown

9. Current sanitary status

You will be asked to send a recent health report according to FELASA guidelines (including result of the examination for Mouse Noro Virus (MNV)) immediately after submission of the request form. The health status of the mice is a major criterion for our decision to accept you request. Please be aware that you will have to provide a second health certificate at the time point of import of the mice. If the health status has changed in the meantime we cannot guarantee that the mice can be accepted.

Detected viruses, bacteria, parasites, etc (max. 1000 characters):*

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II. Are there particular intellectual property rights linked to this MML?

Is the use of this MML restricted by any intellectual property right including those of third parties arising from patent rights, license agreements or other rights of use? Is this MML subject to any kind of agreement resulting in restrictions regarding publication of data? In case this MML is not subject to any of the aforementioned rights please tick 'no'.

Yes

Unknown

If yes, please specify (max. 500 characters):*

Did you generate the MML yourself?*

Yes

Are you the exclusive owner of the MML?

Yes

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III. Shipping information

For the phenotypic analysis (primary screen) of your mutant mouse line you have to provide at least 20 males and 20 females (mutants) and 20 males and 20 females (wildtype). The wildtype animals have to be littermates of the mutant animals. The animals have to be sent when they are 5 weeks old and genotyped (age limiting is the youngest mouse, which must be 6 weeks old on a Monday, when it enters the first screen). The maximum age difference between youngest and oldest is 10 days. If the groups don't have the appropriate number of animals, the import of mice will be rejected. The Mouse Provider has to keep us informed about the progress of breeding and the preparations for shipping (e.g. start of breeding, birth dates). Problems during the transport might have negative implications on the number of animals that can be phenotyped as well as on the results.
For heterozygous breeding with average litter size and fertility we recommend to use at least 40 breeding pairs. If the request is accepted, we will assign a time slot for mating the breeding pairs. When is the earliest time point for the mating of the appropriate amount of couples (2 females can be mated with one male, please consider mean litter sizes of your mutant, mean inter-litter interval, number of animals in colony)?

Do you need support to design your breeding? (we could tell, when and how many mice have to be mated, etc)*

Yes

What kind of mouse labeling system are you using?*

IV. EMMA
If you are interested in the cryopreservation of your mutant mouse line, please contact the European Mouse Mutant Archive (EMMA)

V. Comment
If you have further information or comments, please enter here (max. 500 characters):

GMC at the Helmholtz Zentrum München | Ingolstaedter Landstrasse 1 | 85764 Munich/Neuherberg | Germany