Material Transfer Agreement (MTA)

Provider Institution: Recipient Institution: Provider Contact: Recipient Contact:

Description of Material

Name or Description of Material: Quantity/Amount: Purpose of Transfer:

1. The Material will be used only for the following research purpose:

2. The Material will not be used in humans or for clinical applications.

3. The Material will not be transferred to any third party without prior written consent of the Provider Institution.

4. Intellectual property and publication policies:

5. Other conditions:

Name: Title: Date:

Signature:

Name: Title: Date:

Signature: