Principal Investigator (Must be faculty or academic professional administrative staff.)
Name (Last name, First name MI): Phone Number:
Mailing Address: Pager or Cell Phone Number:
TAMUK Employee ID:
Occupational Position:
Faculty Staff Note: Students cannot be Principal Investigator.
Fax:
Email:
University Department:
Person preparing this document if different from above
(Last name, First name):
Project/Course Title:
Email Phone Number
Brief Summary of Goals and Activity. Use language that is understandable to those with a general knowledge of biology, and define all acronyms. (200 word limit):
Forms Submitted for IBC Review
Potential or Incidental Infectious Agent Exposure Form
rDNA Exempt Form
Recombinant DNA and Artificial Gene Transfer Form
Infectious Agent Usage Form
Biological Toxins Usage Form
Decontamination Plan Form Waste Disposal Plan Form
1.1 Type of Application: New Protocol 3-year Renewal of IBC #
(If this is a 3-year resubmission, do not use language referring to the previous protocol or grant in this form.)
Anticipated Start
Date:
Revised: 10/29/13 1

Please do not send grant applications to the IBC
Name of Sponsor:
Address:
Contact Person:
Grant number
(if available):
Type of Project :
Grant:
Teaching
Unfunded research projects
Will be submitted
Submitted
Approved. The duration of grant approval: 5 years Other:
This application must be written for a maximum of three years only. IBC applications expire after 3 years, at which time a new application will be requested.
Human subjects
IRB protocol number:
Whole animals; Species:
Common Name of Species:
Pending
Approx. number:
IACUC protocol number: Pending
Does this project involve the creation of transgenic or knockout animals*?
No
Yes
*If you purchase transgenic or knockout animals from a non-University vendor, check “No”.
Does this project involve inoculation of animals?
No
Yes. Indicate the amount and route of administration:
Concentration or range of inoculation :
Whole plants; Species:
In vitro work (cell culture):
Cells used in these experiments (check all that apply):
Human Cells Plant Cells
Non-human Primate Cells
Animal Cells (non-primate)
Insect Cells
Other:
Microorganisms; Species:
Fungi; Species:
Insects; Species:
Revised: 10/29/13 2

List the personnel that will be working on this study below (including students and temporary staff). For each individual conducting the experiments, list their degree, applicable training, relevant experience (including duration) and their role in the project and indicate whether they should receive correspondence about the study from the IBC.
Please Note: It is the responsibility of the Principal Investigator to log onto the CITI program at https://www.citiprogram.org/Default.asp
? or to log onto TrainTraq in Single Sign On at https://sso.tamus.edu/Logon.aspx?ReturnUrl=%2f and select the appropriate biosafety training courses for their personnel. These classes should be listed in the table below. At a minimum, the IBC requires that all personnel listed on an approved IBC protocol be required to take the CITI Basic Biosafety course.
Name
(Last Name, First
Name MI)
TAMUK
Employee or
Student ID
Role in
Project
Degree / Years of Experience with Protocol Procedures
Training Classes
Required by
Principal
Investigator
Date Training
Completed*
*Note: Successful completion of all training classes is required for IBC protocol approval. PI is responsible for ensuring all relevant training modules are completed for all personnel involved. A copy of the completed training module certificates for listed personnel should be submitted with the IBC protocol to the Research Compliance Liaison in the Office of Research and Sponsored Programs.
Assurance by Principal Investigator
Submission of this form and associated forms confirms my agreement to perform all activities according to the NIH
Guidelines for Research Involving Recombinant DNA Molecules and use biosafety practices described in the
CDC/NIH Publication Biosafety in Microbiological and Biomedical Laboratories (BMBL) . This application accurately and completely reflects the activities described in any grant, contract, or non-funded research.
Additional conditions required by the Institutional Biosafety Committee on behalf of Texas A&M University-
Kingsville will also be followed.
Signature of Principal Investigator: Date:
You have reached the end of this form. Please make sure that you have responded to every question on this application (even if your response is “not applicable”). Please make sure that you have signed the assurance statement.
Submit to:
Research Compliance Liaison
Email as PDF to: OSR@tamuk.edu
Mail Code: MSC 201
Fax: 361-593-3409
Revised: 10/29/13 3