ࡱ> MOL KDbjbj .F3FF\4.-:ggggBBB$ $u>BB>>$gg>gg>g&D_8T^0G"GGB(PBBB$$BBB>>>>GBBBBBBBBBF O: Roger Williams University Institutional Animal Care and Use Committee (IACUC) Application to Change an Approved Protocol All research projects or course activities involving the use of live vertebrate animals must be reviewed and approved by the Institutional Animal Care Committee (IACUC) prior to project initiation and/or animal acquisition. This form is appropriate for requesting approval for minor changes to an already approved protocol. Investigators wishing to make major changes or to introduce a new protocol, should complete the application form for new protocols (link) Roger Williams University policy requires that all investigators make an effort to limit the use of vertebrate animals to studies which have scientific merit and/or significant educational value and for which alternative model systems do not exist. For a more complete statement of university policy, please visit the 91 IACUC webpage:  HYPERLINK "http://departments.rwu.edu/mns" http://departments.rwu.edu/mns. All faculty, staff and students preparing to submit a protocol to the IACUC committee must first complete the online training course at  HYPERLINK "http://www.citiprogram.org" http://www.citiprogram.org. Please select Roger Williams University in the participating institutions drop down box. New users will be prompted to create a user name and password. Select the CITI Recommended Learner group for HSR or Lab/Animal Welfare. This application may be submitted electronically or printed out as hard copy. Electronic submissions will be accepted at  HYPERLINK "mailto:iacuc@rwu.edu" iacuc@rwu.edu provided the principal investigator provides an electronic signature or a signed hard copy of the 91 statement of assurance page (link). For paper submissions, bring the original and 6 copies to the chair of the IACUC committee (link). Application to Change an Approved Protocol Faculty Investigator ______________________________________ Home Phone or Cell Phone#___________________________________ Phone # ____________ Email Address _________________________ Campus Address: ____________________________________________ Protocol Type: % Faculty Research % Student Research % Class Activity Project Title:_________________________________________________ Date of Original Project Approval: _______________________________ Original Protocol Number (internal use): __________________________ Nature of the change to the existing approved protocol: Check all that apply % New Investigator (faculty), same procedures % New Investigator (student), same procedures % New Animal Species, same procedures % New Number of Animals Required, same procedures % New Permits Obtained % New Analgesic, Anesthetizing, Euthanizing agent % New Drug, Experimental agent, same basic procedure and purpose % New Location for Study % Other Minor Change - explain: _______________________________ Complete the relevant sections: New Investigator: ____________________Home or Cell Phone#___________ Campus Phone # _______________ Email Address____________________ Campus Address: ________________________________________________ New Student Investigator: _____________________________________ Phone # _______________ Email Address_________________________ Local Address: ___________________________________________________ Is this research part of a thesis? Y N Will you receive academic course credit? Y N Will you be paid to work on this project? Y N If yes, source?____________ New Animal Species: Common Name: Reason for change: New Number of Animals Involved: Explain change. Justify any additional animals involved: New Permits Required/Obtained: Attach copies of applicable state or federal permits Permit Agency: Permit Number: Expiration Date: New Analgesic, Anesthetizing, Euthanizing agent: Describe and justify change New Drug, Experimental agent, same basic procedure and purpose: Identify new agent. Describe reason for change. New location for study Oz{}] _ | L M  I i x ǿweXwPEh.th,POJQJh"OJQJh1wh3n0JOJQJ#jh1wh3nOJQJUh3nOJQJjh3nOJQJUh.th/OJQJh.th"OJQJh.thOJQJh&OJQJh.thOJQJh^OJQJhhOJQJh.th^5CJOJQJaJh&5CJOJQJaJh.th5CJOJQJaJNO{|}^ _ M N BCop @ ^@ `gdYm $^a$gd &d P gd"gd"gd,P$a$gdx y  ] !CDERS*붠tg_Th.th<[OJQJhOJQJh.th/0JOJQJ#jh.th/OJQJUjh.th/OJQJUh.th7OJQJh.th/OJQJh 4h,POJQJh.th,POJQJhLh,P0JOJQJ#j hLh,POJQJUh0#Wh,POJQJh,POJQJjh,POJQJU*ABCDcnopw8VX|pgp^RJJBhv /OJQJhOJQJhYmh5OJQJhl%5OJQJh"&5OJQJhYmhl%5OJQJhYmh75OJQJh"hl%5CJOJQJaJh"h75CJOJQJaJhYmOJQJhhQO5CJOJQJaJh5CJOJQJaJhQO5CJOJQJaJh"OJQJhl%OJQJh.th/OJQJh.thl%OJQJXZHtz nL`gdQO &d P gd"&gd" "$FHNPnrtxz>jܪ䢗xphx\TLThQOOJQJh"&OJQJhQOhQO5OJQJhOJQJhk OJQJh7OJQJhYmh75OJQJh7hOJQJh7hl%OJQJhv /OJQJhYmhl%OJQJ^JhYmOJQJ^Jhl%OJQJ^J hl%hl%CJ$OJQJ^JaJ$hl%OJQJhYmOJQJhYmhYm5OJQJhlOJQJ  ~npr ",˻˕vvveWMhkOJQJ^Jh"&CJOJQJ^JaJ hQOh"&CJOJQJ^JaJhQOCJOJQJ^JaJ hQOhQOCJOJQJ^JaJhQOOJQJh;Gh"CJOJQJaJh;GhQOCJOJQJaJh;GhQO5CJOJQJaJh;GOJQJhOJQJh"OJQJhlOJQJh"&OJQJh"&h"&5OJQJ,:<JLNP0246>@NPZhjlvºạn`SSh;Gh;GOJQJ^Jh;GCJOJQJ^JaJ hQOh;GCJOJQJ^JaJh"&h"&OJQJh"&5OJQJh"&CJOJQJ^JaJ hQOh"&CJOJQJ^JaJhkOJQJhQOOJQJhQOCJOJQJ^JaJ hQOhQOCJOJQJ^JaJh"&OJQJhkOJQJ^Jh"&h"&OJQJ^JL2h*,$%fgh,-dgd7 ^`gdQO`gd;G`gdQO&(*,4LRz#$%efghlʶy¶mʉʉyehk OJQJh;Ghv /5OJQJhlOJQJh7OJQJhv /OJQJhOJQJhYmOJQJhYm5OJQJh;GhYm5OJQJh;Gh"&5OJQJh"OJQJh;GOJQJh;Gh;G5CJOJQJaJhQOOJQJh;GhQO5OJQJh;GOJQJ^J&(*+K@]^N8O8d8gdk^gdkgd;G`gd;G*+/JKL[\ -8>ɽٵɇهɇɇsgsh;Ghk5OJQJh;Gh;G5OJQJh"OJQJhOoMOJQJh;Gh;GOJQJh;G5OJQJh"5OJQJhOoM5OJQJh"&OJQJh"hk 5OJQJh;GOJQJhk OJQJhlOJQJhlhl5OJQJh"&5OJQJhZ5OJQJ(>A\^88L8M8N8O8T8\8a8c8d8888888׻qg_WIhOoMhZ5OJQJ\hOoMOJQJhv /OJQJhpOJQJ^Jhkhk5OJQJ^Jhk5OJQJ^Jhkh;G5OJQJ^JhkOJQJ^Jh;GOJQJ^Jh;Gh;GOJQJ^JUh;GCJOJQJ^JaJh;Gh;G5OJQJ^Jh;Gh;G5OJQJh;GOJQJh;Gh;GOJQJh;G5OJQJIdentify new location and any new safety precautions that must be considered Other Minor Change- Describe and justify change_____________________________________ Roger Williams University Institutional Animal Care and Use Committee (IACUC) Change to Approved Protocol: Review Status Sheet Original Protocol Number: __________ Date Change Submitted: __________ Review Date: ______________ Investigator: ________________________________________________ Project Title: ________________________________________________ IACUC Committee Recommendation for Change to Existing Protocol: % Approved Change % Conditionally Approved with Revisions (see comments attached) % Rejected (see comments attached) % Changes require a new proposal applicad888888888+9,9Q9R9t9u9999999(:*:,:gdZ ^`gdZ$a$gdZ <^gdOoMgdOoM`gdk8888 999%9*9+9,959P9W9^999999&:(:,:j::::::::::򳨠zzzi_hZOJQJ^J h#DhZCJOJQJ^JaJhZ5OJQJh-45OJQJh#DhZ5OJQJh-4OJQJhZOJQJh#DhZOJQJhpOJQJhZ5CJOJQJaJh-45CJOJQJaJh.thZ5CJOJQJaJh;G5CJOJQJaJhp5CJOJQJaJ ,:.:::::^;`;;;DDIDJDKDgdZ:::b;d;;;;;<DDDD(D*DHDIDKD±{{rhZ5OJQJhhZ5OJQJhhZOJQJ^JUhhOJQJ^JhCJOJQJ^JaJ h#DhCJOJQJ^JaJhOJQJ h#DhZCJOJQJ^JaJhZOJQJhZOJQJ^J#h#DhZ5CJOJQJ^JaJtion Signature of IACUC Committee Chair: ______________________________ ,1h/ =!"#$%  DyK http://departments.rwu.edu/mnsyK Vhttp://departments.rwu.edu/mnsyX;H,]ą'cDyK http://www.citiprogram.orgyK Phttp://www.citiprogram.org/yX;H,]ą'cDyK iacuc@rwu.eduyK *mailto:iacuc@rwu.edu^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH DA`D Default Paragraph FontRiR  Table Normal4 l4a (k (No List 6U@6  Hyperlink >*B*phFVF  FollowedHyperlink >*B* phHH ,P Balloon TextCJOJQJ^JaJPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] 3Fx *,>8:KD!Ld8,:KD x DR3XXX8@0(  B S  ?DD4\$DPP g,e|fLgoNNT]5     S\gg5   9*urn:schemas-microsoft-com:office:smarttagsplace=*urn:schemas-microsoft-com:office:smarttags PlaceName 5 ALVf5333333355:9 0P b k l%"&I"4(O)(-/v /B4}b=rAjlB;GOoM,P<[\YmpZ.t1GtTxH6{ ijl=x-45P&r 3n^`dmQO#D"|7k35@Hp 3@0@p@:@UnknownG* Times New Roman5Symbol3. * Arial5. *aTahomaACambria Math"1h@٦@٦6jFV "V "!24d**2qHX ?2!xxRoger Williams UniversityAndrew StaroscikFrancis.CherylOh+'0 0< \ h t Roger Williams UniversityAndrew Staroscik Normal.dotmFrancis.Cheryl2Microsoft Office Word@F#@B%@_8@_8V՜.+,D՜.+,D hp|   " * Roger Williams University Title Php _PID_HLINKS_AdHocReviewCycleID_EmailSubject _AuthorEmail_AuthorEmailDisplayName_PreviousAdHocReviewCycleID_ReviewingToolsShownOnceAD#mailto:iacuc@rwu.edux4http://www.citiprogram.org/:4http://departments.rwu.edu/mns7mIACUC documentsdanderson@rwu.eduDelia Andersonw  !"#%&'()*+-./0123456789:;=>?@ABCEFGHIJKNRoot Entry F P_8PData $1Table,GWordDocument.FSummaryInformation(<DocumentSummaryInformation8DCompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q