IACUC_application_form - Revised 12/11/02 IACUC #:_...

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Revised 12/11/02 IACUC #:___________ Framingham State College Institutional Animal Care and Use Committee Proposal Application Date Submitted: Principal Investigator/Rank: If Student, Supervising FSC Investigator: Campus Address: Campus phone: Proposal Title: Purpose: (check one) Research Teaching Course #: Student Participation Type of Application: (check one) New Housing/Breeding Protocol Pilot Controlled Substance/Biohazard Renewal Protocol # Amendment Protocol # Project Start Date: Project End Date: Study Endpoint: (check one) Return to Colony Return to Wild Euthanasia Other, Describe: Brief, Non-Technical Description of the Proposed Animal Use: 1
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Revised 12/11/02 IACUC #:___________ 1. Personnel Name/Rank Training and Experience Procedures 2. Animals Species/Strain Source Sex Age # Individuals 3. Housing/Breeding Protocol Check one: ___ Includes new housing/breeding protocol ___ Previously approved housing/breeding protocol, provide FSC IACUC Protocol #: __ ___ Housing/breeding protocol not applicable Housing/Breeding Protocol for this Project: - Location where animals will be housed: - Environmental Parameters: - Caging: - Bedding: - Feeding: - Maintenance Schedule: - Breeding: - Other: 4. Experimental Procedures Check off each of the following that apply to this project and complete the corresponding section indicated.
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IACUC_application_form - Revised 12/11/02 IACUC #:_...

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