APPLICATION FOR MODIFICATIONS TO AN APPROVED PROTOCOL
Towson University
Institutional Animal Care and Use Committee (IACUC)
Please submit to IACUC at ospr@towson.edu. If this paperwork is not submitted by the PI of the protocol, please
copy the PI on the e-mail to document that he/she is aware of this protocol change.
APPROVED PROTOCOL NUMBER:
APPROVED TITLE:
PRINCIPAL INVESTIGATOR:
Is this modification being submitted as a result of a comparative review? Yes No
Is this modification being submitted as a result of a grant review? Yes No
CHECK ANY CHANGES TO BE MADE TO THE APPROVED PROTOCOL:
Adding a new species
Increasing the number of an already approved
species
Deleting a species
Adding a new procedure**
Changing an approved procedure
Adding or changing therapeutic/anesthetic agents
Changing the method of euthanasia
Changing animal use location
Changing mailing address, phone or pager numbers
Adding new personnel
Removing personnel
Adding or changing Hazardous Agents
Other (please describe):
**If this modification includes new procedures, I certify that I have consulted with the following sources and, to the
best of my knowledge, the new procedures requested in this protocol do not unnecessarily duplicate previous
experiments or unnecessarily use animals (Check all applicable sources): National Agricultural Library,
Library of Congress, Medline, Other (please specify):
Please attach a detailed summary of your proposed changes to this application form. Send completed
application materials to ospr@towson.edu
or The Office of Sponsored Programs and Research
Administration Building, Suite 212E. Allow six weeks for IACUC review. Please note that changes
may not be implemented until you receive notice that the protocol modification is approved by the
Towson University IACUC committee.
PI Signature: Date:
OFFICE USE ONLY
Approval for inclusion of this modification into the approved protocol has been granted by the IACUC on:
and will continue for the current approval period which ends on:
.
Approval for this change will continue to be effective upon Annual continuation approval or until the protocol is
terminated.
Signature of IACUC Chair or designee Date
Rev: 3/18/14
