Animal Request Form

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Animal Care and Use Program
Animal Request Form
For all animal requests, please complete and submit this form to:
Sue Wright
Research Ethics and Administration Officer
Office of Research
Lakehead University
955 Oliver Road
Thunder Bay, ON, Canada P7B 5E1
Office: (807) 343-8283
Fax: (807) 346-7749
Email: [email protected]
Please Note: The time necessary to process a request is variable, and additional health surveillance testing may be
required. Please allow as much time as possible before the animal shipment is desired.
General Information:
AUP #
Principal Investigator:
Email:
Phone:
AUP title:
Name and information of contact person (if other than Principal Investigator):
Requested arrival date:
(Please allow for conditioning and quarantine times before animals can be used in an experiment)
Animal Information:
Species:
Strain (and Strain Code if known):
Total number of animals requested:
Immune status : Normal
□
Number of females:
Deficient
□
Number of males:
Unknown
Costs:
Cost per animal: $
Estimated shipping costs: $
Budget Code for animals and shipping charges (include object code):
-1-
Age, weight, or size requested:
□
Animal Care and Use Program
Animal Request Form
Supplier Information:
□
These animals are coming from one of the following approved vendors (please check below):
□ Charles River Laboratories
□ Jackson Laboratories □ Harlan □ Taconic
□ These animals are coming from another non-approved source? (please specify, including full address
and contact person at the exporting facility)
Exporting Facility Information:
Name:
Address:
Phone:
Contact name:
Contact email:
Please Note:
Most animals that originate from sources other than the above approved vendors must enter the facilities under a
veterinary supervised quarantine. The animals may be quarantined for approximately 8 weeks. All costs
associated with quarantine of these animals will be the responsibility of the importing investigator. Contact the
University Veterinarian for more information and to determine if your animals require quarantine.
For rodents from non-approved sources: A Rodent Import Supplemental Form will need to be completed by the
Exporting Facility and submitted to the Lakehead University Veterinarian for review and approval. A letter of
import approval from the Veterinarian must accompany this animal request.
Housing and Use Information:
Location of housing (facility and room):
Have you contacted the Facility Manager about
this request? Yes □
No □
Do these animals have special housing or husbandry needs?
No □
Yes □ (please describe)
Will you be breeding these animals? Yes □
Will these animals be housed longer than 3
months?
Yes □
No □
No □
If longer than 3 months, have you discussed Health
Monitoring requirements with the University
Veterinarian?
Yes □
No □
-2-
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