Harvard Office of Technology

Main OTD Site

MTA Incoming Submittal Form

Please select the type of organization from which you are requesting the material.

 Non-profit institution
      If you are requesting a material from a university or other academic research institution.
 For-profit organization
      If you are requesting a material from a for-profit organization.

Incoming Material - Non-profit Institutions

Please take a few moments to provide us with some information pertaining to your request. The more information you provide, the easier it will be for OTD to process your request.

Basic Contact Information

Contact information of the individual requesting the Material: (?)

First name:
 Last name:
 Phone:
Email address:
Note: A copy of this submission will be sent to this email address.
Title:
Department:

Are you the Principal Investigator? (?)

Yes No

Is the PI an HHMI Investigator? (?)

Yes No

Please specify the PI's affiliation: (?)

FAS
HMS
HSPH
HSDM
SEAS
WYSS

Contact information of the Provider (including email and institution): (?)

Material Information

Specific name of Material(s) being requested from the Provider: (?)


Are you receiving vertebrate animals? (?)

Yes
No

Is the Material (including any data) of human origin? (?)

Yes
No

Does handling the Material require more than the standard laboratory precautions or safety measures (i.e. studies involving recombinant DNA, synthetic nucleic acids, viral pathogens, bacterial pathogens, prions, biological toxins, human blood and tissues, non-human primate blood and tissues, clinical gene transfer, and/or clinical xenotransplanation)? (?)

Yes
No

Has the Material been published? (?)

Yes
No

Will you be receiving any confidential information along with the Material? (?)

Yes
No
Use of the Material

Please provide a short description of your research in which the Material will be used: (?)

Will you be (check all that apply): (?)

Modifying the Material?
Using it as it is?

In addition to the Material, will you and the other party share any of the following? (Check any that apply) (?)

Lab space
Lab members
Funding
Resulting data
Additional material(s)
None of the above

Please specify the funding source(s) to be used for your research with this Material (check all that apply): (?)
Industry sponsor name(s):
Federal contract(s) or grant(s) – sponsor name(s)
Nonprofit grant – grantor name(s):
Internal Harvard Funds:
Other
Other Information

Are there alternative sources from which the Material may be obtained? (?)

Yes
No

If you have the Provider’s MTA, please attach it to your request prior to submitting. (?)

Please provide any other pertinent email correspondence or information related to your request that you think will help expedite the process.

Please provide email addresses for any additional individuals you wish to have included on correspondence related to this request.

To complete your request, please click the "SUBMIT REQUEST" button:

Incoming Material - For-profit Organizations

Please take a few moments to provide us with some information pertaining to your request. The more information you provide, the easier it will be for OTD to process your request.

Basic Contact Information

Contact information of the individual requesting the Material: (?)

First name:
 Last name:
 Phone:
Email address:
Note: A copy of this submission will be sent to this email address.
Title:
Department:

Are you the Principal Investigator? (?)

Yes No

Is the PI an HHMI Investigator? (?)

Yes No

Please specify the PI's affiliation: (?)

FAS
HMS
HSPH
HSDM
SEAS
WYSS

Contact information of the Provider (including email and institution): (?)

Material Information

Specific name of Material(s) being requested from the Provider: (?)


Are you receiving vertebrate animals? (?)

Yes
No

Is the Material (including any data) of human origin? (?)

Yes
No

Does handling the Material require more than the standard laboratory precautions or safety measures (i.e. studies involving recombinant DNA, synthetic nucleic acids, viral pathogens, bacterial pathogens, prions, biological toxins, human blood and tissues, non-human primate blood and tissues, clinical gene transfer, and/or clinical xenotransplanation)? (?)

Yes
No

Has the Material been published? (?)

Yes
No

Will you be receiving any confidential information along with the Material? (?)

Yes
No
Use of the Material

Please provide a short description of your research in which the Material will be used: (?)

Will you be (check all that apply): (?)

Modifying the Material?
Using it as it is?

Are you planning to (check all that apply): (?)

Investigate the Material itself (e.g., properties, new uses)?
Use the Material as a research tool to study things other than the Material itself?

Will the Material be commingled with materials received from third parties? (?)

Yes

What are the names of these other materials and who provided them?

No

In addition to the Material, will you and the other party share any of the following? (Check any that apply) (?)

Lab space
Lab members
Funding
Resulting data
Additional material(s)
None of the above

Please specify the funding source(s) to be used for your research with this Material (check all that apply): (?)
Industry sponsor name(s):
Federal contract(s) or grant(s) – sponsor name(s)
Nonprofit grant – grantor name(s):
Internal Harvard Funds:
Other
Other Information

Are there alternative sources from which the Material may be obtained? (?)

Yes
No

If you have the Provider’s MTA, please attach it to your request prior to submitting. (?)

Please provide any other pertinent email correspondence or information related to your request that you think will help expedite the process.

Please provide email addresses for any additional individuals you wish to have included on correspondence related to this request.

To complete your request, please click the "SUBMIT REQUEST" button: