Request for Transfer of Animals between Institutions (Sending or Receiving Animals)
Name of Principal Investigator Sending Shipment:
Address:
City: State: Zip:
Phone No.: Fax No.: e-mail address:
Name of Contact in Laboratory Animal Facility:
Phone No.: Fax No.: e-mail address:
Name of Attending Veterinarian:
Phone No.: Fax No.: e-mail address:
Species to be sent:
Number of Animals: Proposed Shipment Date:
Health Status:
Have these animals been used in previous research?
Yes* No
*If “Yes” attach a brief description of the research and provide IACUC protocol number.
#
Name of Principal Investigator Receiving Shipment:
Address:
City: State: Zip:
Phone No.: Fax No.: e-mail address:
Name of Contact in Laboratory Animal Facility:
Phone No.: Fax No.: e-mail address:
Name of Attending Veterinarian:
Phone No.: Fax No.: e-mail address:
If animals will be used in future research, provide IACUC protocol number: #
To the best of my knowledge the above information is correct. I agree that the transportation of these animals will be in compliance with all federal, state, and local and UNCW laws, regulations, and policies.
Signature of Principal Investigator:
Print Name of Principal Investigator:
IACUC USE ONLY: UNCW IACUC APPROVAL OF REQUEST TO TRANSFER ANIMALS:
IACUC Chair Signature: Date: