Annual Continuation App - California State University ...



Date received:Date Approved:PROTOCOL #:CSUF INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE CONTINUATION / COMPLETION FORM(revised 03/20/2020)Protocol #: Principal Investigator:Student/Co PI:Project Title:Complete the required sections below. Submit one signed digital copy via email to the IACUC Coordinator (iacuc@fullerton.edu; 657-278-7719). Contact the IACUC Coordinator or Chair (pstapp@fullerton.edu; 657-278-2849) if you have any questions. SECTION I. 1. PROTOCOL STATUS (select the one statement that applies)? Project inactive, no work has been done and no work will be done. Complete Section I only.? Project completed, no further work with animals will be done on this protocol (may be renewed with a new application). Complete Sections I and II only. ? Project pending; anticipated start date is _________. Complete Sections I, II, and III.? Project active. Complete Sections I, II, and III.2. NATURE OF THE PROTOCOL/STUDY (check all applicable items)? Observation? Inducement of a Disease State? Antibody Production? Survival Study? Behavioral Study? Prolonged Restraint? Terminal Study? Withholding of Food or Water? Multiple Survival Surg.? Blood Tissue Collection? Field Study? Other (detail) _____________________________________________________________________SIGNATURES I certify that the information given in response to the questions on this form is accurate. Signature of Principal Investigator DateSignature of Student/Co PI (if applicable)DateSignature of IACUC Chair Indicating IACUC ApprovalDateSECTION II. 3. ASSURANCE? Yes ? NoHas this project been conducted in accordance with the most recent IACUC approval? If “No”, provide a detailed explanation and justification for the deviation.4. NUMBER OF ANIMALS USEDPlease note the number of animals of each species approved in the original protocol, and the number used to date. If the number of animals approved is not sufficient to complete the project, please request additional animals in the FUTURE PLANS section below. Repeat rows as necessary for each species/strain.# Approved# UsedSpecies/StrainCommon NameYR1YR2YR3TotalYR1YR2YR3Total*To add rows, place your cursor in the right-most cell in the table above and press “Tab” on your keyboard.5. PROGRESS REPORTPlease describe your progress on the project to date (1-2 paragraphs). You may also attach a copy of your grant progress report or publication. 6. PROBLEMS/ADVERSE EVENTS? Yes ? NoWere there any unexpected problems or adverse events, morbidity, or mortality? If “Yes”, please describe the events/problems and the steps that were taken to resolve them.SECTION III. Required for Active or Pending projects only. 7. PROJECT FUNDING? Yes ? NoHave there been any changes in external funding for this project since the last approval?If “Yes”, please list the sponsor and grant number, if applicable.8. PERMITS? Yes ? NoDo all personnel have the permit(s) from outside agencies that are required for the project? Attach copies of all new permits and renewals for any that have expired since the last continuation or new application.9. PROJECT PERSONNEL[NOTE: Any personnel handling or assisting regularly with care of live vertebrates must complete a Medical Health Questionnaire with EHS and the PI must submit a Job Duties form describing their responsibilities.]? Yes ? NoHave there been any personnel/staff changes since the last approval was granted?If “Yes”, please list the following information: Name, Status (Addition/Deletion/Change in Responsibility), Role in Project, Qualifications, and Effective Date. Provide evidence of completion of CITI training and any other training for any new personnel.10. FUTURE PLANS? Yes ? NoAre there any changes planned to the protocol previously approved by the IACUC? If “Yes”, give a full description and justification for the proposed changes. Any proposed changes must be approved by the IACUC before they can be implemented.11. ALTERNATIVES TO ANIMAL USE[NOTE: If your project involves potentially painful procedures, USDA requires that a search for alternatives to potentially painful procedures be conducted every year.]? Yes ? NoSince the last IACUC approval, have you become aware of any alternatives to the use of live animals or a species “of lower phylogenetic order” that could be used to achieve any of your specific research aims? Explain. State literature search or sources consulted. [NOTE: If you search online databases, USDA requires that you provide details on database(s) searched, key words used, the date the search was done, and dates covered by the search.] If “Yes”, explain whether you will modify the approved protocol and, if so, how.? Yes ? NoSince the last IACUC approval, have you become aware of any alternative procedures that could be used to achieve any of your specific research aims? Explain. State literature search or sources consulted. [NOTE: If you search online databases, USDA requires that you provide details on database(s) searched, key words used, the date the search was done, and dates covered by the search.] If “Yes”, explain whether you will modify the approved protocol and, if so, how. ................
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