Research Faculty Off-Boarding Questionnaire

Name of Faculty Member*

First Last

Please provide the best email address to contact you at after your departure from HSC.*

Name of your new institution or employer.*

Final day at HSC*

MM/DD/YYYY

Current Department at UNTHSC*

Other Department*

Will you be requesting the transfer of any awards or contracts to your new institution?*

Notes*

Do you plan to transfer any materials to your new institution (e.g. cell lines, reagents, viral vectors, animal models)?*

Notes*

Do you have any proposals for external funding currently under consideration by a sponsor?*

Notes*

Do you have active IACUC or IRB protocols?*

Notes*

Do you plan to transfer any laboratory equipment to your new institution?*

Notes*

Do you have any radioactive materials, controlled substances, or hazardous chemicals in your lab?*

Notes*

Do you plan to transfer any animals to your new institution?*

Notes*

Do you have any active IBC protocols?*

Notes*

Do you have any Radiation equipment (X-ray, LSC counter and Laser) in your lab?*

Notes*

Are there any other special concerns or needs that the Research Division should be made aware of?*

Notes*