The Pennsylvania State University
Animal Resource Program 	
Export       
		Request for Animal Exportation 
Send completed form to: arp@psu.edu	

Penn State Investigator Complete Page 1:               	
	
Penn State Investigator Information:	
Name of PSU Investigator:	     	
Name of Lab Contact:	     	
Phone  Number:	     	
Email:	     	
Date:	     	

Animals Information:	
Species:	     	
Number of Animals, Gender, & Age:	      Male	Age:      	      Female	Age:      	
Building/Facility:	     	Room #	     	

Strain and Genotype:	
     	     	
     	     	
     	     	
     	     	

Destination: (Receiving the Animals)	
Name of Investigator:	     	
Name of Institute:	     	
Contact from Destination:	     	
Contact Email:	     	
Contact Phone: 	     	
Contact Fax:	     	

Animal Resource Program Complete Page 2:	
	
ARP Export Check off:	
 Completed Import Request Form       
 Health Surveillance Report Sent        
 Authorization to Ship                          
 Shipping Address and contact           
 Health Certificate Signed                   	

Destination Name and Shipping Address:	
     	

Shipping Courier and Account Number: