Principle Investigator ________________________________________________ Department _____________________________ Ext __________
Animal Utilization Protocol # AUP Title _________________________________________________________________________
_________________________________________________________________________________________________________________________
*Emergency Contact Name Emergency Contact Phone Number ______________________________
Animal Care Committee Use Only
Animals Approved: AUP Next Review Date: AUP Expiry Date: Approved by:
Qty Species Strain Sex Age/Weight Date required
CAF Office Use Only Unit Costs
Purchase, Maintenance,
Technical or Supply Charges
For ALL import/export of genetically modified mice, a completed “Mouse Passport” must accompany this form.
Is Accommodation Required? Yes (please specify below) No
Length of stay __________________________________
Please choose location from below; if other please specify: _____________________________________
For Isolation facility: OMAFRA PROJECT # ___________________ Signature of UofG-OMAFRA Poultry Species Coordinator________________________________
Is a Biohazard Permit required? *If required, does CAF Staff have a copy? Yes No To Follow
Biohazard Permit # _________________________________
Source of animals:
Housing Instructions:
Special services or instructions:
___________________________________
Signature of Faculty Member
___________________________________
Signature of Department Chair or Head
3-FUND 6-UNIT 6-GRANT 6-PROJECT 5-OBJECT 9-TBD
REQUEST NUMBER
(to be assigned by CAF Office)
This request is for (please choose one):
Received
ACC/MF/PM/Accounts
Technician / ISO
Order ___________________
Schedule
Census
Confirm _________________
Updated Dec 2017 CM
Animal Purchase and Maintenance
Central Animal Facility (Building 12)
No
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