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Application to use animals in research

HOPE COLLEGE
APPLICATION TO USE VERTEBRATE ANIMALS IN
RESEARCH, TESTING, OR INSTRUCTION

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:
(If you will be using external funds, please use the same title as the grant application)
Funding Source:
Application Period (Start & End Dates):
Previous approval number and date:

(Approved applications must be renewed yearly by using form 94-1, Renewal/Modification Application for Vertebrate Animal Use. Modifications to previously approved applications may be proposed using the same form.)

(Please read General Information and Instructions, Hope College Principles for the Care and Use of Laboratory Animals, and Hope College Guidelines for Vertebrate Animal Users prior to completion of this form.)

1. NUMBER OF ANIMALS. Estimate the number of animals that will be used during the application period according to species and to HUMANE USE CATEGORY. Detailed descriptions of each HUMANE USE CATEGORY can be found below.
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. DESCRIPTION OF PROJECT Please use non-technical language that a lay person can understand. Provide a summary description of this research, testing or instruc-tion-al project, including:
(a) the aims and objectives of the study; and
(b) the probable benefits of this work to human or animal health, the advancement of knowledge, or the good of society.
3. JUDICIOUS USE OF ANIMALS. Guidelines issued by the United States Government entitled Principles for the Utilization and Care of Vertebrate Animals Used in Testing, Research, and Training require that animals selected for a procedure should be of an appropriate species and that the minimum number required to obtain valid results should be used.
3a. Provide a rationale for the selection of the animal SPECIES that will be used in this project. Describe the biological characteristics of the animal that are essential to the proposed study. Describe any experience with the proposed animal model and manipulation.
3b. Provide a rationale for the NUMBER of animals listed in Question #1. Describe the size and number of experimental groups; number of animals needed for procedure development; link animal use to scientific goals.
3c. The Federal Animal Welfare Act requires that you describe how you determined that acceptable alternatives [e.g., mathematical models, computer simulation or IN VITRO biological systems] to the use of animals in this project are not available.
4. EXPERIMENTAL PROTOCOL. For each species, describe the animal use procedures (e.g., surgery, behavioral training, administration of substances for testing, etc.). BE CERTAIN TO INCLUDE INFORMATION UNDER THE FOLLOWING HEADLINES:
a. PROCEDURE:
Details of the procedure to be performed on each animal including the time frames and intervals in the order in which each procedure will be performed. If the procedures are to be performed on the animals or tissues after the animals are killed, so state.
b.

ANESTHETICS:
Anesthetic, analgesic, tranquilizer, test substance(s), and agent(s). Include dose(s) and route(s) of administration.
c.

EUTHANASIA:
Method(s) of euthanasia.
d.

ADVERSE EFFECTS:
Describe (using nontechnical language that a layperson can understand) any anticipated adverse effects on the animal's well-being.
5.

PERSONNEL INVOLVED IN PROJECT. Identify the individual(s) who will:

a. Oversee general animal care:
b. Provide daily husbandry care of animals:
c. Report ill or injured animals to the Director of Laboratories:
d. Perform experimental or test procedures (non-surgical):
e. Perform surgical procedures (if applicable):
f. Monitor the animals during the post operative or anesthesia recovery period (if applicable):
g. Perform euthanasia on the animals:
h. Train the personnel identified in a. - g. above:
6. OCCUPATIONAL SAFETY & HAZARDOUS MATERIALS
a. Participation in the Hope College Health Program for Animal Care Workers and Users is required of all persons having contact with non human primates, domestic carnivores (dogs, cats), farm animals (sheep, cattle, swine, goats) or wild caught mammals, or 8 hours or more per week contact with other species. List here all personnel to whom the requirement applies. If none, enter "None".
b. Does the research, testing, or instruction require the use of hazardous agents in the animal facility (i.e., infectious agents, carcinogens, toxic chemicals, radioisotopes)? If "Yes", specify the hazardous agents to be used and describe the containment protocol to be followed in protecting other animals and personnel from the hazardous agents.
YES NO
7. SOURCES, CONDITIONING AND LOCATION OF ANIMALS
a. Will the animals be acquired from a biological supply company? (Check): Yes/No. If "Yes", identify the company (name and address). If "No", identify the source (e.g., a pet shop, location for wild trapping, etc.).
YES NO
b. Will the animals undergo multiple survival surgical procedures (counting surgical procedures from previous protocols)? (Check) Yes/No. If "yes, please provide justification.
YES NO
c. Will any animals from this protocol be used in other projects at a later date? (Check): Yes/No. If "Yes", please be aware that HCACUC approval is required prior to undertaking a new project.
YES   NO
d. Will this project use dogs, cats, non-human or farm animals? (Check): Yes/No.If "Yes", describe the quarantine and conditioning procedures to be performed prior to the start of the project.
YES NO
e. Location of animal housing:
Building:
Room No.(s):
Off Campus Site(s):
f. Location of animal surgical facility (if applicable):
Building:
Room No.(s):
Off Campus Site(s):
g. Location of laboratory in which the experimental procedures described in 4a will occur (if applicatble):
Building:
Room No.(s):
Off Campus Site(s):
8. 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: