FORM B
UNIVERSITY COMMITTEE ON LABORATORY ANIMALS
RENEWAL AND AMENDMENT FORM
PROTOCOL NUMBER:
PROJECT TITLE:
PRINCIPAL INVESTIGATOR:
DEPARTMENT:
Is this a RENEWAL with AMENDMENTS?
Yes: ☒ No: ☐ If YES, complete PART 1 AND PART 2
Is this an AMENDMENT only of an approved protocol?
Yes: ☐ No: ☐ If YES, complete PART 1 only
Is this a RENEWAL only of an approved protocol?
Yes: ☐ No: ☐ If YES, complete PART 2 only
PART 1 – AMENDMENT(S):
NOTE: Only minor amendments to existing protocols can be approved on a FORM B. Substantial modifications, such
as a change in experimental objectives, or an increase in the category of invasiveness, will require a new
FORM A submission. Only amendments that fall under the objectives in the original FORM A should be
included.
a. What are the objectives stated in FORM A?
b. Describe any amendments to this protocol, including changes in animal species / strain, housing, procedures,
pharmacological agents, etc. Include changes to animal handling / care / outcomes that may result from these
changes. Justify additional animals requested for this amendment.
c. Why are these amendments necessary?
d. Are additional animals required for this amendment? Yes: ☐
No: ☐
If yes, what species and how many additional animals/species?
e. Add any new personnel involved in this protocol. (Include: Name, position, certification #, phone # for each):
List any personnel who have left the project:
Principal Investigator SIGNATURE: _________________________________________ DATE:
(Office use only) Approval Date: ___________________________________________
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Revised August 2015
FORM B
PART 2 – RENEWAL
NOTE: Approved protocols can be renewed/extended for one additional year. At the end of the second year a
complete protocol application (FORM A) must be submitted for ongoing work.
ANIMAL NUMBERS
a. For each species, what is the TOTAL number of animals you justified in the experimental design of the Form A
you submitted last year?
b. How many animals of each species did you actually use last year (year 1)?
c. For each species, how many animals will you require for the upcoming year (year 2)?
The numbers in (b) plus (c) should be less than or equal to the number in 2(a). If not, then you are requesting
animals that were not justified in the original protocol. In that case, please fill out the amendment section (Part
1) of this form, including additional animal numbers is section c, and justifying their use is section b.
PROGRESS REPORT:
a. Briefly describe the progress made in this study to date:
b. Describe any unexpected animal morbidity or mortality encountered under this protocol.
What percentage of animals were affected?
c. Have you refined any of the experimental techniques in order to improve animal wellbeing?
If so, please describe.
d. Were the humane endpoints you described in Section 7 of the original protocol adequate to achieve
experimental objectives, while still ensuring animal welfare? Yes: ☐ No: ☐
Comments:
e. For field studies, were any non-target species captured or adversely affected?
If yes, how many were affected, and what happened to them?
PERSONNEL:
If there are any changes in the personnel involved in this project please complete the appropriate section in PART 1.
Principal Investigator SIGNATURE: _____________________________________________ DATE:
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Revised August 2015