Material Transfer Agreement (MTA) Quick Form, Outgoing MSSM PI Name * PI Email Address * Recipient Institution/Company * Recipient Contact * Recipient Contact Email * Name of Material Requested * Type of Material Requested * Compound Cell Antibody Animal Patient Sample DNA Other If Other above, please describe Will the requesting scientist and/or any other company scientist actively collaborate in research with your lab in which the material will be used? * Was the material made in your own lab/collected at MSSM (were you the PI for the activities that resulted in creation of the material)? * Did any other research lab provide essential components or otherwise collaborate with you in making the material? * Have you described the material in a publication? * Is the material the subject of an invention disclosure, patent, or a patent application? * Is the material licensed to any third party, or the subject of licensing negotiations? * Has the material already been sent to the requesting scientist? * Did your lab receive industrial, government or philanthropic foundation support for the research in which the material was made/collected, lab salaries of those working on the project, or any supplies used in the research that generated the materials? * Do you wish to charge a shipping, handling, or transfer fee for the material? * If Yes above, please indicate $ amount If you are providing human derived samples or tissue, has the MSSM IRB approved the transfer? * 
