Mouse Mutant Online Application

Please fill out the following information. Upon completion, click submit.

Principal Investigator Information

Last Name: *

First Name: *

Institution: *

Street Address 1: *

Street Address 2:

City: *

State: *

ZIP/Postal Code: *

Country: *

Email: *

Phone Number: *

Primary Contact Information (if different from PI)

Last Name:

First Name:

Institution:

Street Address 1:

Street Address 2:

City:

State:

ZIP/Postal Code:

Country:

Email:

Phone Number:

Mutant Information

Name of Mutant:

Phenotype Class:

(e.g. embyronic lethal, deafness, etc.)

Phenotype Description:

(1-2 paragraphs; list any publications that may describe the mutant or how it was isolated)

Type of Mutation:

(e.g. ENU-induced, spontaneous, strain difference, etc.)

Strain on which mutation arose:

Has this mutant been mapped?:

Mapping Strategy:

Briefly describe the mapping strategy used to identify the critical region (e.g. F2, backcross, congenic, etc.)

Size of Interval (if known)::

Chromosomal Location:

(i.e., the critical region): What loci define the proximal and distal boundaries of the critical region? Do NOT simply list genome coordinates. If the loci (Mit markers; SNPs; etc.) are NOT in public databases, then provide their sequences. Attach a spreadsheet or figure summarizing the genotyping data of progeny with respect to the chromosomal region of interest. Use mm9 (Build 37) for genomic coordinates.

How many Refseq genes and exons are in non-recombinant interval?:

List genes that you have already analyzed by sequencing::

List genes that have known mutant phenotypes::

Do you have reason to believe that the mutation may NOT lie within the coding regions or splice junctions of a gene?:

Pre-publication Submission Plan:

Briefly outline plan for pre-publication submission to public repository; e.g. the Mutant Mouse Regional Resource Centers (http://www.mmrrc.org/)

Please confirm that the mutant line has not been and, if approved, will not be submitted elsewhere for sequence analysis:

Please read the Data Publication Statement:: *

I have read the data publication Statement and agree to the terms listed for release of the data .