Annual Review Form
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University of North Dakota
IACUC PROTOCOL ANNUAL REVIEW FORM
NOTE: For processing, submit the signed, completed form via email to: UND.iacuc@research.UND.edu
The Animal Welfare Act and UND IACUC Policy require annual review and approval of animal use
protocols. In order to continue this protocol for another year, you must complete this form and return it
to the IACUC Office. Please respond to the following items to ensure that your protocol is current.
Easy to Use Template Instructions: Simply tab to the gray blocks and type in your information. The box will expand
as you type. To select a box of your choice, simply point the mouse to the box and click!
Failure to return this form to the IACUC will result in suspension
of your animal use approval.
Date Submitted
Primary
Investigator
Protocol No.
Department
Phone
Address
E-mail
Fax
Project Title
Funding Source
Protocol Expiration Date
Please circle your answers to the questions 1-5. A "yes" answer on questions 2-5 requires an
explanation on a separate sheet. All replies must be typed.
1. Do you want the above animal use protocol continued? (If "no" your protocol will be terminated)
Yes No
2. Have there been any changes in the approved project with respect to: experimental procedures,
the animal model, animal pain or discomfort?
Yes No
3. Has the availability of alternatives to the use of animals changed in the past year? Yes
No
4. Have any adverse effects or unanticipated problems been observed while conducting this study?
If yes, please discuss how these problems were resolved (as an attachment).
Yes No
5. Do you wish to change the currently approved number of animals to be used over the next year?
If yes, submit an amendment form.
Yes No
6. Discuss the status of the research described in the current protocol: If the project is active, provide
a short paragraph (as an attachment ) regarding progress toward the specific aims of the protocol
(is your progress on the protocol as expected when originally submitted). If experiments under the
protocol have not been conducted this year and your protocol is set to expire, please explain why
it needs to remain in force.
7. List the names, department and contact information of all individuals approved (on original
Revised 10/29/2015
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protocol plus additions) to conduct procedures involving animals under this protocol (as an
attachment).
Investigator signature
Date
IACUC Chair
Date
Institutional Veterinarian
Date
Revised 10/29/2015