Institutional Animal Care and Use Committee Keith J. O’Neill Center for Healthy Families, Room 208 2300 Adams Ave., Scranton, PA 18509 (570) 961-4778 email: APPLICATION FOR ANIMAL USE IN RESEARCH AND TEACHING The purpose of this application is to determine if proposed animal use is in accordance with both Marywood University and Federal Regulations. Marywood this determination. Incomplete application packages will not be University’s IACUC will make reviewed. TITLE OF STUDY: Name: Principal Investigator (PI) University Status: Academic Department: __Faculty Mailing/Campus Address (room, building, street address): __Staff __Doctoral Student __Graduate Student Phone: Email: __Undergraduate Student __Researcher from outside CITI Use of Animals Basic Course Completion Date: Marywood University Responsible Conduct of Research (RCR) Course Completion Date: __Other Specify:_______ – Co-Investigator Name: University Status: Academic Department: __Faculty Mailing/Campus Address (room, building, street address): __Staff __Doctoral Student Phone: Email: __Graduate Student __Undergraduate Student CITI Use of Animals Basic Course Completion Date: __Researcher from outside Marywood University Responsible Conduct of Research (RCR) Course Completion Date: __Other Specify:_______ – Sponsor/Advisor Name: University Status: Academic Department: __Faculty Mailing/Campus Address (room, building, street address): __Staff __Doctoral Student __Graduate Student Phone: Email:
Institutional Animal Care and Use Committee Keith J. O’Neill Center for Healthy Families, Room 208 2300 Adams Ave., Scranton, PA 18509 (570) 961-4778 email: APPLICATION FOR ANIMAL USE IN RESEARCH AND TEACHING The purpose of this application is to determine if proposed animal use is in accordance with both Marywood University and Federal Regulations. Marywood University’s IACUC will make this determination. Incomplete application packages will not be reviewed. TITLE OF STUDY: Principal Investigator (PI) Name: University Status: __Faculty __Staff __Doctoral Student __Graduate Student __Undergraduate Student __Researcher from outside Marywood University __Other – Specify:_______ Academic Department: Mailing/Campus Address (room, building, street address): Phone: Email: CITI Use of Animals Basic Course Completion Date: Responsible Conduct of Research (RCR) Course Completion Date: Co-Investigator Name: University Status: __Faculty __Staff __Doctoral Student __Graduate Student __Undergraduate Student __Researcher from outside Marywood University __Other – Specify:_______ Academic Department: Mailing/Campus Address (room, building, street address): Phone: Email: CITI Use of Animals Basic Course Completion Date: Responsible Conduct of Research (RCR) Course Completion Date: Sponsor/Advisor Name: University Status: __Faculty __Staff __Doctoral Student __Graduate Student Academic Department: Mailing/Campus Address (room, building, street address): Phone: Email:
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