ANIMAL USE PROTOCOL AMENDMENT FORM
SIGNIFICANT CHANGES
This form may be used for significant changes to previously approved protocols and will be reviewed by the
IACUC at a convened meeting. Significant changes include a change in the objective of the study, from nonsurvival to survival surgery resulting in greater discomfort or in a greater degree of invasiveness, an increase
(>10%) in animal numbers, change in species, change in PI, change in the use or withholding of anesthetic and
analgesic agent(s), change in the method of euthanasia, use of hazardous materials and changes in the duration,
frequency, or number of procedures performed on an animal. Requested changes must be within the scope of
the original research hypothesis. Changes cannot be implemented prior to IACUC approval.
Date Submitted
Protocol Number
Protocol Title
Principal Investigator
Changes to be made (Applicant should note which sections(s) of the original approved protocol are to be
changed, then state the new wording to reflect the changes needed):
Reason for Changes:
I understand that any failure to comply with the guidelines and requirements of the IACUC may result in suspension of my studies and
notification to the funding agency, the PHS and/or USDA as mandated by law.
PI Signature and date:
Please return electronically in Word format to: iacuc@uwlax.edu
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IACUC Use Only Below This Line
The above changes have been reviewed and approved by the IACUC and may be implemented.
IACUC Chair Signature or designee
Date: