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: Animal Use Protocol Modification Form Significant Change – Please use this form to request an amendment to your currently approved animal use protocol. This form is only to be used for SIGNIFICANT changes made to your currently approved protocol. Complete items #1-5 on the form and any applicable items #6-11. Submit the completed amendment with the principal to the Office of Research, for Healthy Families, Room 208. investigator’s signature O’Neill Center STUDY INFORMATION Date: _______ MU IACUC #: ____________ Principal Investigator Name: __ ______ ____ Phone: _______ E mail: _____ __ ______ ____ Study Title: Principal Investigator Signature: ______________________________________ Type of modification Check all changes that apply and complete the corresponding sections below: Strain If phenotype could potentially affect the welfare of the animal – A. Describe the phenotype and list any conditions that are not normal in healthy animals. B. Describe the course of action that will be taken to relieve pain/distress. How will the animals be monitored and by whom? Addition and/or removal Species – Please describe what species you would like to add to this protocol and provide scientific justification as to why this species is required. Increase in animal numbers from the total numbers approved in the original submission:
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: Animal Use Protocol Modification Form – Significant Change Please use this form to request an amendment to your currently approved animal use protocol. This form is only to be used for SIGNIFICANT changes made to your currently approved protocol. Complete items #1-5 on the form and any applicable items #6-11. Submit the completed amendment with the principal investigator’s signature to the Office of Research, O’Neill Center for Healthy Families, Room 208. STUDY INFORMATION Date: _______ MU IACUC #: ____________ Principal Investigator Name: __ ______ ____ Phone: _______ E mail: _____ Study Title: __ ______ ____ Principal Investigator Signature: ______________________________________ Type of modification Check all changes that apply and complete the corresponding sections below: Strain – If phenotype could potentially affect the welfare of the animal A. Describe the phenotype and list any conditions that are not normal in healthy animals. B. Describe the course of action that will be taken to relieve pain/distress. How will the animals be monitored and by whom? Species – Addition and/or removal Please describe what species you would like to add to this protocol and provide scientific justification as to why this species is required. Increase in animal numbers from the total numbers approved in the original submission:
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