INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC)
California State University, Northridge
ANIMAL SUBJECTS PROTOCOL RENEWAL REQUEST
(A copy of previously approved protocol must accompany this form. You may sign this form electronically and send
this via email to daniel.rastein@csun.edu)
Name
Date
Department
Extension
Title of Project
Project Period
Prior Approval Date
Certification
By signing below I am stating my intention to perform the same experiment for which I have
received prior Institutional Animal Care and Use Committee approval and certifying that there
are no changes in the protocol. I have attached a copy of the previously approved protocol to
this form.
Signature
Date
Additional Comments:
For RSCH Use ONLY
Approved:
Signature of IACUC Chair (or Institutional Official)
Date
IACUC RENEW 01/16