FORM C
UNIVERSITY COMMITTEE ON LABORATORY ANIMALS
Application to use INVERTEBRATES, tissues obtained at NECROPSY or obtained from a SLAUGHTERHOUSE
FORM C – INFORMATION:
Note: This application is for investigators using invertebrate species for research or teaching, for which the Canadian
Council on Animal Care does not require detailed information. This includes the use of eggs, protozoa or
other single-celled organisms; experiments involving containment, incision or other invasive procedures on
metazoa. It is the expectation of the CCAC that animals of all species, including invertebrates used in
research or teaching projects will be treated humanely including the use of anesthetic or analgesic agents
when appropriate with rapid and humane forms of euthanasia.
This category excludes higher invertebrates with complex nervous systems (i.e. all cephalopods) - for these
species, detailed information on the FORM A application is required.
This application may also be used for investigators wishing to use tissues obtained at necropsy or from a
slaughterhouse.
Information requested on this form will enable the office for the University Committee on Laboratory Animals to sign
investigator's grant application forms to indicate that the UCLA has approved the proposed use of invertebrates,
tissues obtained at necropsy or from slaughterhouse as required by many granting agencies.
Please send electronic version and one signed paper copy to UCLA secretary.
Approval of this application will extend the project for a two year period. At the end of this period you will be
required to re-submit another Form C.
Jennifer Wipp
Administrator - UCLA
Dalhousie University
PHONE:
FAX:
EMAIL:
494-1270
494-1516
UCLA@dal.ca
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Revised August 2015
FORM C
UNIVERSITY COMMITTEE ON LABORATORY ANIMALS
PROTOCOL NUMBER
Application to use INVERTEBRATES, tissues obtained at NECROPSY or obtained from a SLAUGHTERHOUSE
PRINCIPAL INVESTIGATOR (Faculty Member):
DEPARTMENT:
POSITION:
PHONE:
FAX:
PROJECT TITLE:
FUNDING SOURCE:
OBJECTIVES OF PROPOSED ANIMAL USE:
SPECIES TO BE USED:
APPROX. # USED ANNUALLY:
SOURCE OF TISSUE/SPECIMENS:
METHODS OF ANESTHESIA/EUTHANASIA (IF APPLICATION):
DECLARATION: All animals used in this research project will be cared for in accordance with the recommendations of
the Canadian Council on Animal Care and the policies of Dalhousie University.
Principal Investigator SIGNATURE: _________________________________________ DATE:
(Office use only) Approval Date: ___________________________________________ DATE:
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Revised August 2015