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Do you want to send materials to someone else? (Outgoing MTA)

If you have received a request from another academic or not-for-profit institution, please fill out the following form completely (Note: If you have been requested to provide material to a for-profit entity, contact Yale's Office of Cooperative Research ) :

Yale Principal Investigator (head of laboratory)

  • Name:
  • Title:
  • Telephone:
  • E-mail:

Yale Contact (if different than PI)

  • Name:
  • Title:
  • Telephone:
  • E-mail:

  1. Please provide complete contact information for the Recipient Scientist including Institution, Department, Address, Telephone and Fax Numbers, and E-mail address.
  2. What is the specific name of the material, and how much will you send?
    (This information will go on the MTA)


  3. Will any confidential information be included with the material or otherwise provided to the Recipient Scientist?


  4. Will the recipient pay for shipping? If yes, the MTA will ask for a courier account number.


  5. Will the recipient pay for the preparation of the material? If yes, what amount should be listed on the MTA? NOTE: your business office will need to invoice the recipient, if required.


    6. Note: If you have previously sent this material under this same specific name,               you may stop here unless the information below has changed.

  6. Is there a publication that describes this material(s)? If so, please send the citation. If not, please provide a description of the material, and let us know when you do intend to publish.
  7. Was the material entirely developed by you at Yale? Were other investigators, at Yale or elsewhere, involved in the development?
  8. Is the material derived from other materials obtained or purchased from a third party?
  9. What funding supported development of the material?
  10. Is the material subject to any third party agreement or restrictions (such as a sponsored research agreement, grant, license agreement, MTA, etc?)
  11. Is the material of potential value?
  12. Have you submitted a disclosure to OCR for the material? If possible, please provide the OCR disclosure number. (See: http://www.yale.edu/ocr/disclose.html )
  13. Is the material hazardous or a select agent?
  14. To your knowledge, is the material subject to export controls or any other shipping restrictions?
  15. Is the material derived from a human subject or otherwise requires HIC approval? If so, please provide the number of the approved HIC protocol, or provide us with a copy of the HIC letter of exemption.

 

Last update: November 21, 2008 (MS)