WICHITA STATE UNIVERSITY
INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC)
ANNUAL ANIMAL TISSUE REVIEW FORM
Project Description Utilizing Animal Tissues but Not Live Animals
Date:
Principal Investigator:
Protocol Title:
Protocol #:
Funding Source:
Date of Initial Approval:
Expiration Date (for this reporting period):
Animal species tissue(s) to be utilized:
1. Protocol Status
A. Active - project ongoing
B. Currently inactive - project was initiated but is presently inactive.
C. Inactive - project never initiated but anticipated start date is:
2. Source of animal material: (List the name(s) of the sources of the animal tissues, for
example Yoder Meats, Yoder, KS. If coming from another approved protocol, please list the
protocol #.)
3. Project Personnel: Please list all personnel working on this project
Role/Responsibility for Project