Permit Request • CampusOptics

Complete this form for A&M-SA research sample transportation on public roads between campuses or from other destinations.

Requester Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Permit Date & Time

Start Date* Required

Start Time* Required

Expiration Date* Required

Expiration Time* Required

Location

Name* Required

Additional Location Details

Shipping Information

Driver/Carrier name:* Required

Investigator name:* Required

Origin of the samples (Country): * Required

CDC/APHIS ePermit# (if applicable):* Required

PI Cell phone #:* Required

A&M-SA Ref #:* Required

Specimen Information

Species of animal to be transported (list all):* Required

Strains of biological samples (list all):* Required

Type of research sample (list all):* Required

Number of animals/vials/items in shipment:

Mark box for all those that apply. * Required

The animals*/ samples have NO known infectious agent, chemical or radiation hazard
The animals/ samples have been treated with a chemical or pharmacological hazard
The animals/ samples have been infected with a hazardous microorganism (bacteria, virus, or parasite)
The animals/ samples have been treated with a radioactive substance
Other

If you choose Other for the previous question, please explain:* Required

Transporting Hazards From:

Campus/Institution:* Required

Building:* Required

Principal Investigator/Laboratory Contact:* Required

Phone number:* Required

Date of shipment:* Required

Transporting Hazards To:

Campus/Institution/Vendor:* Required