Monoclonal Antibody Production Request Form

1. Requestor
2. NAME:
   

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   PRINCIPAL INVESTIGATOR:

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   LAB ROOM #____________ Phone #____________________________

3. Request monoclonal antibodies (MAbs) to:
4. 1. Single or multiple specificity to epitope(s) of antigen needed: ____________

       

   2. Specific isotype(s) needed: _____________________________________

       

   3. Describe antigen; its purity, quantity, pathogenicity, etc:

       

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5. Justify the need for MAbs including their potential role in public health or their necessary utility in your research program:
6. 
    
   

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7. Provide verification that a search has been performed to document that monoclonal antibodies do not exist to this antigen.
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9. Describe the objectives to be achieved with these MAbs and how these MAbs will be used, e.g., disease diagnosis, identification of microorganisms, inhibition of receptors, etc.:
10. 
     

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11. Need for a screening test:
12. 
    Assay for screening is established in my lab.________
    Screening is by _____________________________
    Assay sensitivity is ___________________________
    Request for development of screening test by MAb Unit. [Form]: BIAcore/Biosensor Analysis Request Form
    Requestor will provide antigen, quantity:

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13. Amount of antigen to be provided for monoclonal antibody productin and characteristics of the antigen (toxicity, infectivity, et.):
14. ________________________________________________________
     
    
    Please Note: Questions or comments regarding animals for mab production should be directed to IACUC.
    
    
15. FUNDING INFORMATION: REQUIRED BEFORE USAGE)
16. 
    HRI ACCOUNT# ___________________________ STATE ACCOUNT# __________________
    Please contact core personnel about the charge fee for usage.
    PI will be billed quarterly.

    ___ I agree that the Immunology Core is an essential active participant in the development of all MAbs.  I further agree to provide all information on characterization of the antibodies and their use in publications and/or patent applications.

    APPROVED BY: (ALL SIGNATURES ARE REQUIRED BEFORE USAGE)

    PI: _________________________________________ DATE: _________

    LAB CHIEF: _________________________________DATE: _________

    CORE DIRECTOR: __________________________ DATE: _________

    Print & Send completed form to:
    Core Contact Personnel Stuart Balaban - BIGGS, C612. Phone 473-7334, Fax 486-1505
    Or Core Director, Dr. David Lawrence BIGGS, C539. Phone 402-5684; Fax 474-1412