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Summary: UNIVERSITY OF VIRGINIA SCHOOL OF MEDICINE
MATERIAL TRANSFER APPROVAL SHEET
OUTGOING MATERIAL
Provider UVA Scientist: Phone:
Department: Email:
Recipient Organization: Phone:
Administrative Contact: Email:
Address:
Recipient Scientist: Phone:
Department: Email:
Address:
Material requested:
Research (Please provide or attach a brief description of the proposed research using the Material):
Yes No
1.A. Was the Material developed/isolated in your UVA laboratory?
1.B. If not, where was the Material developed or obtained?
2. Does the Material constitute or relate to any invention for which you contemplate
making or have made any disclosures to the University of Virginia Patent Foundation for
which there is an issued patent? If so, please explain:
3. Is the use, disclosure or transfer of the Material restricted by any third-party
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