Fillable WICHITA STATE UNIVERSITY INSTITUTIONAL ANIMAL CARE AND USE (Wichita State University)

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WICHITA STATE UNIVERSITY INSTITUTIONAL ANIMAL CARE AND USE (Wichita State University)

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File type: PDF

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Page 1 Form Revised 12/16
WICHITA STATE UNIVERSITY
INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC)
AMENDMENT FORM
Date:
Protocol #:
PI:
Protocol Title:
Animal Species:
1. Describe specific proposed change to the protocol
2. Personnel Changes
If adding personnel please complete the below information. If not applicable mark this box
(If adding more than one person please provide their information on a separate Word document)
Name (First, MI, Last):
Department:
E-mail Address:
Mark as applicable: WSU Faculty Member WSU Grad Student WSU Undergrad Student
Other:
Page 2 Form Revised 12/16
2a. Have new personnel completed CITI Training in the last 3 years: Yes No
(Please contact the IACUC Administrator if more information on CITI is needed – IACUC@wichita.edu)
2b. New Personnel’s Qualifications/Experience:
2c. If new personnel do not have experience, how will they be trained?:
2d. Responsibilities of the new personnel for this study:
Signature of Principal Investigator Date
Signature of IACUC Representative Date
**Email completed application forms to IACUC@wichita.edu.**
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WICHITA STATE UNIVERSITY INSTITUTIONAL ANIMAL CARE AND USE (Wichita State University)

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Completed 25 July 2020

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