Rev. 07/28/14
IACUC Number: B
Boston College
Institutional Animal Care and Use Committee
Breeding Protocol Continuation
PLEASE TYPE
A.
Administrative Data
Principal Investigator:
Mail Address:
Telephone:
Project Title:
Department:
Email:
7. Research Personnel/staff/students: List all personnel who will handle the animals or animal tissues:
Name:
E-mail:
Date of ACF Training:
Name:
E-mail:
Date of ACF Training:
Name:
E-mail:
Date of ACF Training:
Name:
E-mail::
Date of ACF Training:
Name:
E-mail::
Date of ACF Training:
B. Animal Requirements
Total Number of Animals in All Strains to be Bred:
STRAIN A
Number of Animals in this Strain:
1. Genus:
2. Species:
4. Strain, subspecies, or breed:
3. Common name:
5. Common name:
6. Bacteriological status:
[e.g., germfree (axenic), defined flora (gnotobiotic), specific pathogen free, conventional]
7. Viral status:
8. Will animals be housed in BC
Animal Care Facility?
Yes
No
If No indicate the institution, or BC building and room where animals will be housed:
Number of Animals Bred in the Past Year:
STRAIN B
Number of Animals in this Strain:
1. Genus:
4. Strain, subspecies, or breed:
2. Species:
3. Common name:
5. Common name:
6. Bacteriological status:
[e.g., germfree (axenic), defined flora (gnotobiotic), specific pathogen free, conventional]
7. Viral status:
2
8. Will animals be housed in BC
Animal Care Facility?
Yes
No
If No indicate the institution, or BC building and room where animals will be housed:
Number of Animals Bred in the Past Year:
STRAIN C
Number of Animals in this Strain:
1. Genus:
2. Species:
4. Strain, subspecies, or breed:
3. Common name:
5. Common name:
6. Bacteriological status:
[e.g., germfree (axenic), defined flora (gnotobiotic), specific pathogen free, conventional]
7. Viral status:
8. Will animals be housed in BC
Animal Care Facility?
Yes
No
If No indicate the institution, or BC building and room where animals will be housed:
Number of Animals Bred in the Past Year:
STRAIN D
Number of Animals in this Strain:
1. Genus:
2. Species:
4. Strain, subspecies, or breed:
3. Common name:
5. Common name:
6. Bacteriological status:
[e.g., germfree (axenic), defined flora (gnotobiotic), specific pathogen free, conventional]
7. Viral status:
8. Will animals be housed in BC
Animal Care Facility?
Yes
No
If No indicate the institution, or BC building and room where animals will be housed:
Number of Animals Bred in the Past Year:
STRAIN E
Number of Animals in this Strain:
1. Genus:
2. Species:
4. Strain, subspecies, or breed:
3. Common name:
5. Common name:
6. Bacteriological status:
[e.g., germfree (axenic), defined flora (gnotobiotic), specific pathogen free, conventional]
7. Viral status:
8. Will animals be housed in BC
Animal Care Facility?
Yes
No
If No indicate the institution, or BC building and room where animals will be housed:
Number of Animals Bred in the Past Year:
C. Per Diem Expense Chartstring:
Rev. 7/28/14
Submit Completed Materials to iacuc@bc.edu
3
D. Description of Breeding Performed in the Past Year (include the number of animals bred per strain):
E. Description of Anticipated Breeding Needs in the Coming Year and Anticipated Transfers to Research Protocols
(add additional sheets as needed):
I certify that the above is a true account of the status of this project:
Signature of investigator:_____________________________________________________ Date:________________
Rev. 7/28/14
Submit Completed Materials to iacuc@bc.edu