FORT LEWIS COLLEGE
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Name
Address
Title of Proposal
Telephone:
PROPOSED PERIOD OF RESEARCH: late February to mid-March 2012
1.
PURPOSE OF STUDY (In non-scientific terms, describe the portion of the project using animals and the relevance of the project to human/animal health or biology. Include appropriateness of species and number to be used. Be concise.)
2.
ANIMAL PROCUTEMENT AND CARE
Species and Breed/Strain of
Animals
Source of Animals Approx. Number of Animals to be Used for Proposed Study
ANIMAL SUBJECTS
APPROVAL FORM
3.
ANIMAL HOUSING AREA
4.
STUDY AREAS
Will animals be taken to a laboratory or other area and maintained for longer than 12 hours?
___Yes _ _No If Yes, list the room number and building.
5.
ANIMAL USE PROCEDURES
(Respond to all items. For all yeas responses, provide descriptions and additional information in the blanks provided. Attach additional sheet, if required.)

Yes No
__ ____blood sampling (describe techniques, site of collection, volumes, frequency)
___NO ___Sampling of urine/feces (indicate method, e.g. metabolism cage, including dimensions of cage, catheterization, frequency of catheterization, other)
___NO ___Antibody production (indicate route of administration, adjuvant use and frequency, collection protocol, consideration of alternatives to Freunds’s adjuvant)
__YES_ ___ Administration of drugs (other than anesthetics)/reagents/cells/etc. (describe agent, route of administration and frequency, anticipated side effects, monitoring protocol)
One subcutaneous injection of streptozotocin (55 mg/kg)dissolved in citrate buffer (0.01 M, pH
4.5)
Yes No
___YES___Administration of anesthetics (agent, dose, route; if by inhalation, state method of scavenging waste anesthetic gases/fumes)
___ NO ___Administration of analgesics (agent, dose, route, frequency)
___NO ___Infections/potentially infectious agents to humans and/or animals used (describe arrangements for use)

___YES ___Controlled substance, including anesthetics, e.g., pentobarbital (describe arrangements for use/security)
___YES ___Collection of tissues post euthanasia
___ NO ___Special diets (describe any anticipated nutritional deficit)
___NO ___Indwelling catheters or implants (describe size, type, maintenance/monitoring protocol
___NO ___Restraint (describe method, duration)
___NO ___Behavioral testing without significant restraint or noxious stimuli
___NO ___Behavioral testing with significant restraint or noxious stimuli (describe; provide rationale for degree or restraint of stimulus)
___NO ___Tumor transplantation (describe any anticipated functional deficit to the animal, monitoring protocol, endpoint)
___YES ___Toxicity testing and toxic materials (describe procedure, anticipated side effects, endpoint)
6.
METHOD OF EUTHANASIA (specify method, agent, and route of administration; must be consistent with the AVMA Panel on Euthanasia, Journal of Veterinary Medical Association (Vol.
188, No. 3 pages 252-268, 1986), or justification for deviation should be indicated.

7.
If animals are not euthanized, indicate their disposition.
8.
ALTERNATIVES TO LIVE ANIMAL USE
Federal law requires that the principal investigator consider alternatives to procedures that may cause more than momentary of slight pain or distress to the animals. If you have listed animals under Type C, D, or E, on the front page of this approval packet, you must provide a written narrative description. This narrative description must provide details on the methods you used and sources consulted to determine that alternatives are not available or acceptable. As a minimum, the database(s) used to search the literature for alternatives and keywords used should be listed and results noted.
PRINCIPAL INVESTIGATOR ASSURANCE
The information contained on this form provides an accurate description of the animal care and use protocol which will be followed. I agree to abide by governmental regulations and University policies concerning the use of animals. I will allow veterinary care to be provided to animals showing evidence of pain or illness.
If the information provided for this project concerning animal use should be revised, or procedures changes, I will so notify the Committee of those changes. I understand that failure to report significant changes may place the University and myself in violation of federal regulations.
As required by federal regulations, the activities described do not unnecessarily duplicate previous procedures.
_______________________________________________________________________
Signature of Principal Investigator Date