WPC  #˘ ơj#PQ;+8Pf1i pRc>F=jF ԵTMZfup`i'd3ԕA<9nzefg2)hK|5-AOz ,?:mMefs. Oy˵۳ R[Uf|:ŬQ>[$ycs %L5B@߻iebMͨ!`pP;CMPSb/L.{Pb0H ZbWN D[jQri<&.ZŔe?p%LjZT{Ͻ,Yl&>H ☶셱Ҟ 3XH&t?]pN˕hRCHs9JMb6 4me"9*z/ sX% ;$h#! UN+ %y 0(LN 0Dw@4DX^ gse u mUNQHP LaserJet 4MV,,,,,,0(hH  Z 6Times New Roman RegularX($C:\OFFICE\WPWIN\TEMPLATE\STANDARD.WPT )  _aXX.N>D:\01temp\grants\pols\iacuc.wpdND:\01temp\grants\pols\iacuc.wpd/  (3$ !  DDDUUEe&3|x0&c U )  aXX.N>D:\01temp\grants\pols\iacuc.wpdND:\01temp\grants\pols\iacuc.wpd/  (hH  Z 6Times New Roman Regular  !  _   8&Xdd8WESTERNKENTUCKYUNIVERSITY  8  ResearchandEducationalAnimalUseProtocol   JApprovedMarch24,1992  Thisapplicationmustbecompletedforeachseparateanimaluseprojectinvolvingresearch,educationoranyotherrelatedanimaluseactivityoncampus.ThecompletedformmustbesubmittedtotheChairpersonoftheInstitutionalAnimalCareandUseCommittee,Room201TCNW.Anysignificantchangeinanapprovedprotocolrequiresreapplicationusingthisform.Attachacopyoftheoriginalapprovalandcompleteonlythoseitemsonthisformwhichhavebeenchanged.Principal(Faculty)Investigator:_____________________________  Telephone:    StudentInvestigator(s):___________________________________  Telephone:  ______________________________________________________  Telephone:  Department:____________________________________________________________________ProjectTitle:__________________________________________________________________________________________________________________________________________________ProjectDuration(Dates):____________________to__________________________________FundingSource(s):______________________________________________________________ProjectDescription:(Brief,concisebutincludeallanimalrelatedprocedures.(Attachonseparatesheet.)  +%) Completethefollowing:1.0  PersonnelUsingAnimals:(Names,specificexperienceortrainingrelevanttotheproposed  project). (#(# 2.0  StandardOperatingProceduresandPoliciesGoverningProject:(AT&TPolicy,NIHPolicy, p8  AnimalWelfareAct,etc.) (#(# 3.0  HazardousAgentsUsedInvolvingAnimals:(Listallwhichareahumanrisk).(#(# 4.  Animals X    Commonname____________________________ p No._________ x Sex____________ D    Scientificname___________________________________________________________Genus:Species:Rationaleforspeciesandthenumberused:Source:Housinglocation:ResearchUseSiteOtherthanTCNW214:(Howlongwillanimalsexistattheexperimentalsite?) ,'+ Ї5.0  AnimalHealthSurveillanceMeasures:8(#(# 6.0  AnimalPhysicalRestraintMethods: (#(# 7.0  AnimalDiscomfort,Distress,orPain:p8 (#(#   Willdistressorpainoccur?____Yes  ____No  ____Don'tknow H    Ifansweredyesabove,pleasecompletethefollowing:  Drug(s)anesthetic,analgesic,sedative,tranquilizertobeusedtorelievedistressorpain:  Dosageofthedrug(s):  Route/Frequencyofdruguse:  Ifdistressorpaincannotbealleviatedthroughdrugs,pleasejustifythoroughlybelow: ,'+   Willdeprivationoccurduringhousing?_____Yes  _____No 8   Ifyes,justify:8.  AnimalSurgery:______Survival  ______Non-survival    _______Aseptic p8  0  Hasanyanimalbeenused,orwillbeused,inmorethanonemajoroperativeprocedurefromwhichitisallowedtorecover?______Yes p ______No4 (#(#   Ifso,providejustificationplease:  Procedures:  Post-operativecare:9.0  Euthanasia:D (#(#   Method:  Drug:________________________  Dosage:____________  Route:_____________     Rationaleforselectingtheabove:10.0  VeterinarianConsultation:h&0!$(#(#   HaveyouconsultedtheUniversity'sAttendingVeterinarianonthisprotocol?  ______Yes ______No ,)#'   *$( &   11.0  AlternativeProcedures:Documentalternativeproceduresyouconsideredthatrelievemore 8 thanmomentaryorslightpainordistresstoanimals.Outlinethemethodsandgivesources(e.g.,biologicalabstracts,IndexMedicus,etc.)thatwereusedtodeterminethatalternativeswerenotavailable. (#(# '812.0  Providebelowawrittennarrativedescriptionofmethodsandsourcesthatwereusedto  determinethattheproposedactivitiesdonotunnecessarilyduplicatepreviousexperiments: (#(# 13.0  DispositionofAnimals: (#(#   Specifyhandlingofcarcasses:  Specifyanyparticularnecropsyrequirementsorotherneeds: ,'+ IcertifythatIfullyunderstandUniversitypolicyconcerningnecessaryandappropriatetrainingforresearchpersonnelusinganimalsandthateverypersonengagedinthisresearchprojecthasbeenorwillbethoroughlytrainedinthemethodsorprocedurestobeused.AllsuchpersonnelhavebeenmadefamiliarwiththeNIHGuidefortheCareandUseofLaboratoryAnimalsandtherequirementsoftheamendedAnimalWelfareAct.Iagreetomakeeveryreasonableefforttoensuretheproperconductofallpersonsassistinginthisresearchproject.______________________________________________ p ______________________________  L  FacultySignature    h      p   Date p8  ______________________________________________ p ______________________________ H  StudentSignature    h      p   Date 4   IACUCACTION     []Approved  []ConditionallyApproved[]NotApprovedMeetingDate:__________________________Comments:________________________________________________  ________________________ ,)#' IACUCChairperson    h      p     Date *$(