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MTA Quick Form, Incoming
Please fill out the MTA Quick Form below for
materials. A member of OTBD’s Contracts Team will receive the form and follow up with you as soon as possible.
Material Transfer Agreement (MTA) Quick Form, Incoming
MSSM PI Name
Provider Contact Email
Name of Material Requested
Type of Material Requested
If Other above, please describe
Short description of how material be used.
Greatest length of time the research will require.
Will you also receive confidential or proprietary information from the provider?
Will material be used in conjunction with other materials or with equipment received or requested (not purchased) from other providers?
Will your lab collaborate (either at MSSM or another academic institution or a company) on the project in which the material will be used?
Will your lab receive funding from any third parties, industrial, government (Federal grant such as an NIH grant, State grant such as from NYSTEM) or philanthropic foundations, in connection with this research?
Do you have any issued or pending patents, or have you ever filed an invention disclosure related in any way to the research?
Is the material to be received a controlled substance that requires state and/or federal government approval for import, receipt, or use?
If you will receive human derived samples or tissue, has the MSSM IRB specifically approved the use of the materials by your lab?
I am not transferring human derived samples or tissues
Do you have any concerns regarding the terms of the MTA provided by the provider or otherwise regarding this material?
If Yes above, please describe
Please enter any two digits with no spaces (Example: 12)
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Autism Mental Status Examination
Small Molecule-Mediated Directed Cardiomyocyte Differentiation of Human Pluripotent Stem Cells
SUMO1: Therapeutic Target for Heart Failure
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