Animal Research
Protocol #: ARORSP Ref #:
Institutional Animal Care and Use Committee
Continuing Review Form
Directions: Submit this completed Continuing Review Form with original signature(s) along with any
additional information, including appendices, attachments, etc.
Submit to: Office of Research Compliance, 560 N. 16th Street, Room 102
Phone: 414-288-6271
Fax: 414-288-6281
E-Mail: IACUC@marquette.edu
Principal Investigator:
Department:
Telephone:
E-mail:
Project Title:
(If funded, provide the title of the corresponding grant)
PI Certification
This signature certifies that the Principal Investigator has read and understands the requirements of the PHS Policy on Humane Care
and Use of Laboratory Animals, applicable USDA regulations, the Guide for the Care and Use of Laboratory Animals, and the
Marquette University policies governing the use of vertebrate animals for research, testing, teaching or demonstration purposes. This
signature certifies that the PI will maintain the project in full compliance with the aforementioned requirements and that the PI
assumes responsibility for all aspects of this project, including assurance that all research staff involved in handling animals are
qualified and appropriately trained. If grant funded, the PI further certifies that the information stated in this protocol is consistent
with the animal care and use information provided on the grant application. In signing this description of the research project, I agree
to accept primary responsibility for its scientific and ethical conduct as approved by the IACUC.
___________________________________________________________________________________________________________
Signature of Principal Investigator
Printed Name
Date
For Office Use Only
Institutional Animal Care and Use Committee
Date of Approval ____/____/____
Disposition:
Designated Review
Animals Approved (type & number/year): _______________
Full Review
Approved through ____/____/____
__________________________________________________________________
Signature of IACUC Representative
Printed Name
____/____/____
Date
__________________________________________________________________
Signature of IACUC Representative
Printed Name
IACUC Comments:
____/____/____
Date
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Marquette University, IACUC Continuing Review Form
08/2013
***Please note that in order to choose any of the check boxes on this form,
you must double click the box and select "Checked" as the Default
Value***
Section A: PROJECT PERSONNEL
1.
Have there been any personnel/staff changes since the last IACUC approval was granted? This
information can be found on question 7 of the original protocol form. If personnel have been added
since original approval please add personnel/staff in the boxes below. Note: all individuals that are not on
the original IACUC approved protocol will need to be added in this section. Including those added throughout the year
via appendix G.
Yes
No
If Yes, indicate additions/deletions below:
Note that all individuals who handle animals must participate in the Marquette University
Occupational Health and Safety Program. Information on this program will be discussed during
the animal care and use training provided by the Animal Resource Center.
Name
Name
ADDITIONS
That are not reflected in original approved protocol
Role in Lab Contact Contact e-mail Address
Animal Care
Phone
#
(student,
and Use
employee,
Training
(completed or
grad
pending)
student,
post doc,
etc.
Completed
Pending
Completed
Pending
Completed
Pending
DELETIONS
From original approved protocol
Role in Lab Contact Contact e-mail Address
Animal Care
Phone
#
(student,
and Use
employee,
Training
(completed or
grad
pending)
student,
post doc,
etc.
Completed
Pending
Completed
Pending
Completed
Pending
Enrolled in
Occupational
Health and
Safety
Program
Completed
Pending
Completed
Pending
Completed
Pending
Enrolled in
Occupational
Health and
Safety
Program
Completed
Pending
Completed
Pending
Completed
Pending
Please submit completed original to Marquette University’s Office of Research Compliance,
560 N. 16th Street, Room 102, Phone: 414-288-6271, Fax: 414-288-6281
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Marquette University, IACUC Continuing Review Form
08/2013
Section B: PROTOCOL INFORMATION
2. Record of Animal Usage* (over the last year of the protocol). Note: If your animal usage* was over
the allowed 10% or dramatically lower that the total number approved/year in the original protocol,
please address this in the grey box below.
Species
Total No.
Approved/Yr
No. Actual
Used/Weaned/Purchased
Over Past Year
No. Born Over Past
Yr. (breeding
colonies only)
*is the number of animals purchased, obtained from other protocols, breeding offspring, number born
and number used in experiments.
3. Protocol Status
Requesting Protocol Continuance and Project is:
Active; ongoing
Currently Inactive; project was initiated, but presently inactive
Inactive; project was never initiated, but anticipated start date is: ____/____/____
Requesting Protocol Termination because the Project is:
Inactive; project was never initiated
Currently Inactive; project was initiated, but will not be completed
Completed; project has been completed and no further experimentation with animals will be done
4. Do you need a continuing approval letter to be sent to the funding source?
Yes
No If Yes, specify contact person and address:
5. Progress Summary. Please provide a brief summary of your progress with this protocol to date and
include a lay summary of your results over the past year:
6. Did your protocol incorporate a pilot study?
Yes
No
If Yes, provide a summary of the progress with this pilot study and include a lay summary of your
results over the past year:
Please note that any protocol modifications must be submitted separately by completing the
IACUC Protocol Review Form. Modifications must be bolded, italicized, or highlighted to
Please submit completed original to Marquette University’s Office of Research Compliance,
560 N. 16th Street, Room 102, Phone: 414-288-6271, Fax: 414-288-6281
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Marquette University, IACUC Continuing Review Form
08/2013
emphasize that they are changes or additions to the original protocol submittal. Forms are
available on the web at
http://www.marquette.edu/researchcompliance/research/animalcareprotocol.shtml.
Please submit completed original to Marquette University’s Office of Research Compliance,
560 N. 16th Street, Room 102, Phone: 414-288-6271, Fax: 414-288-6281
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