Indicate calorie or nutrient restrictions or excess: Indicate the length of time the animals will be on the experimental diet: Will this project involve injections, immunizations, inoculations or drugs? Please include any paralytic agents that may be used. Please do not include any other injections, inoculations or drugs that will be used for surgery as this will be captured in the surgery section. Yes No Go to Question 4. No- Fill out the reset of Question 3. Yes- Substance Dose Frequency Anatomic Volume Is this (mg/ and Route Site (administered per pharmaceutical kg) of site and total grade? * administered at one time) Yes No Yes No Yes No Yes No Yes No *Attach an Appendix A of non-pharmaceutical grade for each “Administration compounds” substance that is a pharmaceutical grade compound. not I will log all controlled substances per regulations and DEA Law. I am not using controlled substances Yes No Will the animals be anesthetized or sedated during the procedure? Yes* No *If list the anesthetic agent or sedative, including dosage and route of administration. Yes,
Indicate calorie or nutrient restrictions or excess: Indicate the length of time the animals will be on the experimental diet: Will this project involve injections, immunizations, inoculations or drugs? Please include any paralytic agents that may be used. Please do not include any other injections, inoculations or drugs that will be used for surgery as this will be captured in the surgery section. Yes No No- Go to Question 4. Yes- Fill out the reset of Question 3. Substance Dose (mg/ kg) Frequency and Route of Anatomic Site Volume (administered per site and total administered at one time) Is this pharmaceutical grade? * Yes No Yes No Yes No Yes No Yes No *Attach an Appendix A “Administration of non-pharmaceutical grade compounds” for each substance that is not a pharmaceutical grade compound. I will log all controlled substances per regulations and DEA Law. Yes No I am not using controlled substances Will the animals be anesthetized or sedated during the procedure? Yes* No *If Yes, list the anesthetic agent or sedative, including dosage and route of administration.
IACUC%20Submission%20Form%2010-6-15.docx