NATIONAL PRIMATE RESEARCH CENTER
Institutional Animal Care & Use Committee
PROTOCOL AMENDMENT
Office Use Only Sequence:
Amendment Approval Date:
All amendments approved within a three-year period are bound to the approval date of the protocol.
Email completed form to iacuc@tulane.edu
DATE FILED:
EMAIL:
PI:
DIVISION: select one Other:
PROTOCOL #:
or PROJECT #:
TITLE OF PROJECT:
If applicable choose one of the following:
Multiple projects - please indicate which project or projects this applies to:
New project - please contact the Division of Veterinary Medicine (DVM) to set up new number. Please provide
the title if different from the protocol title.
Transfer project: Current project number:
Title:
AMENDMENT REQUEST: Please check all that apply; provide an explanation and justification for each change.
Addition of an experiment
Need to repeat an experiment
Addition of a procedure(s)
Change the schedule of sample collection - You must provide an updated schedule that will replace any previous
schedules in the approved protocol and previous amendments.
Change the dose of a previously approved drug or agent
Change the route of administration for a previously approved drug or agent
Modification to a previously approved procedure
Addition of surgical procedure–Addition of major surgery or change in the USDA pain category for the protocol may
require a new protocol at the discretion of the IACUC.
Change in Principal Investigator
Change the species approved for use by this protocol
Change in animal numbers:
Increase
Decrease
Total number currently approved for: (include all approved amendments)
Addition of animals is due to additional funding. Please contact the DVM to set up a new project number.
Other:
The area below will expand to fit the text entered
DESCRIPTION OF CHANGE (S) - Describe how this amendment changes the original protocol.
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JUSTIFICATION FOR CHANGE (S) - Please provide a justification for each proposed change.
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EFFECTS ON PROTOCOL STATUS - Check “Yes” or “No” as it applies to each question.
A. Will this amendment change the protocol’s Category of Animal Use to a greater degree?
YES
NO
If YES, provide and justify the new Category of Animal Use:
B. Will any aspect of this amendment require the use of animals assigned to other projects?
YES
NO
If YES, list the project number(s), species and # of animals “borrowed”:
C. Will housing / enrichment levels need to be modified to accommodate this amendment?
YES
NO
If YES, describe the changes that will be necessary. Please refer to the guidelines listed in the environmental
enhancement section of the protocol.
D. Will any aspect of this amendment require a change to the hazards associated with this protocol?
YES
NO
If YES, Identify the hazard(s):
It is the responsibility of the principal investigator to notify the funding agency of all modifications to the project.
Principal Investigator Signature
Date
tel 504.988.6868 or 985-871-6636
fax 504.988.1445
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