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Renewal of application to use animals in research

HOPE COLLEGE
RENEWAL/MODIFICATION APPLICATION FOR VERTEBRATE
ANIMAL USE

FOR HCACUC USE ONLY
Approval #___________________________________
Approval Date___________________________________

Department:
Date:
Principal Investigator/Course Instructor:
E-mail Address (incl. @hope.edu):
Mailing Address:
Phone #:
Project/Grant/Course No:
Project/Course Title:
Application Period (Start & End Dates):
HCACUC Approval Number for Previously Approved Proposal:
Renewed or modified applications must be renewed yearly by using this form.

1. Indicate the number of additional animals you propose to use during this application period. These animals must be used following the same protocol as in the previously approved proposal unless modifications described in part 2 of this application are approved.
HUMANE USE CATEGORY
SPECIES (Common Name)
A
B
C
TOTAL
A - Procedures involve little or no discomfort or pain.
B - Procedures may result in some discomfort or pain, but of short duration.
C - Procedures may result in significant discomfort or pain.
2. Please completely describe any modifications from the previously approved proposal. Utilize the approved proposal as a guide for the type of information required. Use additional pages if needed. If no modifications are requested type "none":
3. I acknowledge responsibility for this project. I have read the Hope College Principles for the Care and Use of Laboratory Animals and the Hope College Guidelines for Vertebrate Users and certify that this project will be conducted in compliance with those guidelines and principles. I assure that I will obtain HCACUC approval prior to significant changes in the protocol. I assure that this project does not unnecessarily duplicate previous research or instructional projects. I assure that students, staff and faculty on the project are qualified or will be trained to conduct the project in a humane and scientific manner.

By typing your name in the field below, you electronically sign this Form.

Name: