Submission Application for Creation of
Genetically Modified Pigs

Dear Investigator,

Please use the following form to provide information about the pig line you would like the NSRRC to create.

Please submit the completed form electronically. Completed forms will be reviewed by the NSRRC Steering Committee. Because only a limited amount of funding exists to create models for NIH-funded investigators, only 3 pig lines per year will be approved.

Please complete the following questions. * = required field

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APPLICANT INFORMATION:
Investigator:	*
Institution:
Department/Bldg/Room:
Postal Address
City:
State/Province:
Zip Code/Postal Code:
Country:
Phone:	*
Fax:
Email:	*
List current and pending NIH funding:
PIG LINE DESIRED:
Nature of Mutation:	transgenic knockout
Desired genetic alteration(s):	*
Pig strain on which gene alteration is desired:
Describe expected phenotype:
For what types of research will the swine model be useful:
Describe the rationale for creating this model as a swine model rather than another animal species:
Potential estimate for the demand for this mutant:
Please provide any additional information about the desired swine model that may be useful in understanding the potential value of this model:
Please provide distinguishing characteristics that make the mutant unique: