Incoming Material Transfer Agreement Request

Completion of this form allows OSATT to evaluate the MTA with respect to MIT policy, funding source obligations, and any other obligations under MTAs with other parties.

AN APPROPRIATE RAS/SAPweb ACCOUNT NUMBER FOR THE FUNDING SOURCE(S) WILL BE NEEDED FOR THE REVIEW.

Please attach any MTA(s) received from the provider to this form before submission. If you have any questions regarding MTAs or would like to request an outgoing MTA, please email mtainfo@mit.edu.

MTA

MTA (Material Transfer Agreement) is a legal document that should have been sent to you by the provider institution/company or the scientist you are obtaining the material from.

Do you have an MTA document from your provider?

Yes

Please upload the MTA(s) from your provider:

MIT Contact Information

Contact email:

MIT Principal Investigator (PI):

MIT Researcher/User (if different from PI):

MIT PI affiliation(s) (check applicable):

Media Lab
Lincoln Lab
HHMI
SMART
The Broad Institute

Provider Contact Information

Name of providing institution:

Provider scientist:

Provider contact email:

Materials

Requested material:

Material type:

Scope of Work

What is your intended use of the material? Provide a brief description of proposed experiments.

Funding Sources

Please list ALL sources of funding (federal or private) which will be used to support the research utilizing the requested material. Include the granting agency and the applicable OSP account number (the SapWEB account number).