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IACUC USE ONLY
San Jose State University
Institutional Animal Care and Use Committee
Abbreviated Protocol for Observational Animal Studies
Type and return the completed form with an introductory cover letter and any necessary permits to
the University Animal Care office at extended zip 0100.
1. Principal Investigator:
Co-Investigator:
Department:
phone:
email:
Project Title:
2. Common name of animal(s) to be observed:
Genus and Species:
(Attach list if multiple animals)
Are any animals considered a species of concern, threatened or endangered?
3. List all localities where the observations will be made (note if public or private):
Briefly describe methods and equipment used to monitor study areas:
Is permission required to access or deploy monitoring equipment in study areas?
If ‘yes’, attach all permission notices and provide details in attached cover letter.
4. List all personnel involved, their affiliation and role in project:
Requested IACUC Approval Period (3-year max):
to
5. I hereby assure the IACUC the above information is complete and accurate, and that no
animal will be disturbed, harassed, handled or sampled to support the scientific objectives
herein. I recognize that it is my responsibility to halt observations and promptly notify the
SJSU IACUC if activities described herein adversely impacts animal welfare or behavior.
Signature of Principal Investigator:____________________________ Date:
6. SJSU IACUC Approval
_______________________ ______________________ ________________
Chairperson
Signature
Date