Fillable Vertebrate Animal Form (5B) (Microsoft)

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Vertebrate Animal Form (5B) (Microsoft)

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Page 42 International Rules: Guidelines for Science and Engineering Fairs 2021–2022, societyforscience.org/ISEF
Student’s Name(s)
Title of Project
Title and Protocol Number of IACUC Approved Project
To be completed by Qualiied Scientist or Principal Investigator:
1. Species of animals used: Number of animals used:
2. Describe, in detail, the role of the student in this project: animal procedures and related equipment that
were involved, oversight provided and safety precautions employed. (Attach extra pages if necessary.)
3. Was there any weight loss or death of any animal? If yes, attach a letter obtained from the qualiied scientist,
designated supervisor or a veterinarian documenting the situation and the results of the investigation.
4. Did the student’s project also involve the use of tissues?
No
Yes; complete Forms 6A and 6B
5. What laboratory training, including dates, was provided to the student?
6. Attach a copy of the Regulated Research Institution IACUC Approval. A letter from the Qualiied Scientist
or Principal Investigator is not suicient.
Vertebrate Animal Form (5B)
Required for all research involving vertebrate animals that is conducted at a Regulated Research Institution.
(IACUC approval required before experimentation. Form must be completed and signed after experimentation.)
Qualiied Scientist/Principal Investigator
Printed Name
Signature Date (mm/dd/yy)
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Vertebrate Animal Form (5B) (Microsoft)

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Completed 3 August 2021

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