ࡱ> 130 Vbjbj 7"V r       $00E    [OP.[0'''(00' : THE CITY COLLEGE OF NEW YORK-ANIMAL CARE FACILITY CONVENT AVENUE AT 138 STREET NEW YORK, NEW YORK 10031 212-650-8505 FAX 212-650-7545 Import Request Instructions and Form from Non-Approved Vendors or Other Institutions If an investigator wishes to import rodents from a non-approved source or vendor into the Animal Care Facility, s/he must: Obtain an import request form from the ACF office Marshak Vivarium. Return the completed form to the ACF office. Request a health surveillance report or certificate detailing the most current health status from the animal rooms housing the animals to be sent to CCNY. This information should be obtained from the veterinary staff of the donor institution and attached to this import request form. Receive prior authorization from the ACF Manager, x8515 for receipt of the animals. In most cases, upon receipt the animals will be subject to a quarantine period from 42- 56 days. There will be an additional fee for technical and diagnostic services during the quarantine. In addition: If the incoming animals require special housing or husbandry, you must specify the reasons for the deviations from the normal and describe the special conditions in sufficient detail that it is clear to the husbandry staff, and in accordance with your approved protocol. Typically quarantine space is at a premium, so that breeding during this period is not condoned unless specific, prior arrangements have been made. If you have any further questions, please contact the ACF Manager at x8515. Importor Information (ccny investigator): Name________________________________________________________________________________ Laboratory____________________________________________________________________________ Department____________________________________________________________________________ Phone #_______________________________________________________________________________ FAX #and e-mail address_________________________________________________________________ Home phone number____________________________________________________________________ Secondary contact individual (name and phone #)______________________________________________ Donor Information: Name of contact or collaborator____________________________________________________________ Phone#/FAX #_________________________________________________________________________ Name of animal facility veterinarian or facility manager_________________________________________ Phone#/FAX#__________________________________________________________________________ Institution _____________________________________________________________________________ Address ______________________________________________________________________________ City__________________________________________________________________________________ State_________________________________________________________________________________ Zip code______________________________________________________________________________ Country_______________________________________________________________________________ Animal Information: Species__________ Strain______________ Sex______________ Total Number of Animals to be Received ____________________________________________________ Name of Transgene_______________________Insertional Mutation______________________________ Immune status__________________________________________________________________________ Protocol number________________________________________________________________________ Proposed Housing Location _______________________________________________________________ Special Housing Requirements_____________________________________________________________ Proposed Use of Animals_________________________________________________________________ Protocol No.: Does the institution that the animals are coming from conduct periodic, routine health surveillance programs on its rodent population?__yes __no If yes, please attach the most current health surveillance report to this request form. 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