IACUC Application

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					                                   GEORGIA INSTITUTE OF TECHNOLOGY (GIT)
                         INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE APPLICATION
      Under the Georgia Open Records Act, protocol applications, including information incorporated by reference, may become
      accessible by the general public.

      This PROTOCOL APPLICATION must be approved before any animal work begins. Note the institute policy regarding eligibility
      for the role of Principal Investigator on an animal protocol (See IACUC Policies & Procedures). Occasionally, a large Program
      or Center grant to a single Principal Investigator will fund multiple faculty members’ activities, and the Program or Center
      grant PI may not be a member of the research team on animal protocols that the grant funds. For these “umbrella”
      programs, the IACUC accepts protocols from Principal Investigators who are not PI on the supporting Program/Center grant.

      Attachments: Statement of Work or Proposal Detailing Vertebrate Animal Research
      A copy of the funding proposal or final grant pages sent to the funding agency is required. Federal regulations require the
      IACUC to compare the protocol to the funding proposal Statement of Work or Project Description. Substantive differences
      must be satisfactorily addressed prior to IACUC approval.

      Required Training: Everyone named on the protocol—including students, lab techs, Visiting Scholars, and affiliates—is
      required to complete the online CITI training course, “Working with the IACUC” and the other CITI training modules
      appropriate for the planned work. For example, if the protocol proposes the use of mice or rats, all named personnel must
      complete “Working with Mice (or Rats) in Research Settings.” Refresher training is required every 3 years. The online training
      is linked from the Office of Research Integrity Assurance (ORIA) website at www.researchintegrity.gatech.edu.

      Enroll in Occupational Health Program: Everyone named on the protocol must enroll in the Georgia Tech Occupational
      Health Program, managed by Environmental Health & Safety and provided by contract with Concentra Health Services. An
      opt-out provision is available, but enrollment is still mandatory. See the link to the Occupational Health Program at
      www.researchintegrity.gatech.edu.

      Departmental Sign Off: This prepared IACUC application is to be signed by the applicant’s department head or, in lieu of a
      written signature, department heads may send an email to iacuc@gatech.edu stating that they are aware of the proposed
      work and concur with its submittal to the IACUC. When the department chair is the Principal Investigator named in the
      protocol, no other sign-off is required.

      Preliminary Protocol Submission: Submit the protocol application and attachments to the ORIA via email to
      iacuc@gatech.edu.

      Initial Review Process: The protocol application will be given a preliminary review by the ORIA and then will be forwarded to
      the Georgia Tech Attending Veterinarian/Director of Animal Resources for veterinary consultation. The Principal Investigator
      may be contacted for clarification or additional information. Following veterinary consultation, the protocol will be returned
      to the Principal Investigator for modifications, if necessary.

      Final Protocol Submission: If modifications are required, the Principal Investigator should revise the protocol in accordance
      with the combined veterinary and preliminary consultation and submit the revised protocol to the Office of Research
      Integrity Assurance via email to iacuc@gatech.edu for distribution to the committee. If none are needed, the protocol will
      be forwarded by the Veterinarian to the Office of Research Integrity Assurance for distribution to the committee.

      Committee Review: All protocols are distributed to the committee in the order received. If a committee member calls for
      Full Committee Review (FCR), the protocol will be placed on the agenda for that month’s meeting, unless it was received
      without sufficient lead time. The majority of protocols do not require FCR. However, protocols requiring full committee
      review are due the first of the month for review at that month’s meeting.

      For assistance, contact the Office of Research Integrity Assurance at 404.385.7316 or 404.385.2083. Please note that
      Institutional Animal Care and Use Committee approval is required prior to procurement or use of animals.
Georgia Institute of Technology                                                                                 IACUC@gatech.edu
Office of Research Integrity Assurance                                                                               August 2012
IACUC Protocol Application                                                                                                Page 1
      If the project involves the use of any infectious agent or hazardous chemical (including chemical carcinogen), review by the
      Institutional Biological Materials Safeguards Committee (BSMC) is required. Protocols involving rDNA require review by the
      Institutional Biosafety Committee. See guidance at www.researchintegrity.gatech.edu.

      In cases where other reviews or approvals are required (i.e., Institutional Biosafety Committee, Material Transfer Agreement,
      Office of Technology Licensing, Radiation Committee), those should be sought in parallel. If there are any transgenic animals,
      organisms/agents or proprietary issues necessitating a Material Transfer Agreement (MTA), consult the Office of Technology
      Licensing for guidance.

      IACUC Guidelines are located on the Office of Research Integrity Assurance website at
      http://www.researchintegrity.gatech.edu/forms/IACUC/GIT_IACUC_Policies_and_Procedures.pdf.


      Applications should be saved as a Word file and submitted to the Office of Research Integrity Assurance by email to
      iacuc@gatech.edu



                      Please feel free to delete the above tips and guidance
                            before submitting IACUC application.




Georgia Institute of Technology                                                                                IACUC@gatech.edu
Office of Research Integrity Assurance                                                                              August 2012
IACUC Protocol Application                                                                                               Page 2
                    Application for the Use of Laboratory Animals in Research, Training, and/or Teaching
                                        Institutional Animal Care and Use Committee (IACUC)
                                             Office of Research Integrity Assurance (ORIA)
                                             Georgia Institute of Technology (GIT)
                                                   PHS Assurance # A3822-01


             Submit via email to iacuc@gatech.edu                                    Office of Research Integrity Assurance Use Only
             http://www.researchintegrity.gatech.edu                                              File Number



        1                                                       Title & Funding
        Check category of this project:         New Research Protocol            New Teaching/Training Protocol
                         Renewal (new application after end of 3rd year) If Renewal list old protocol number:
        Check category of this project:            New Proposal                  Renewal (
        Grant/Project Title:
        Source of Funding (Specify sponsor name and Project number even if funding is pending):

        2                                                    Principal Investigator
        Principal Investigator:                  PI Title:                        Department:

        Telephone:                               Emergency number:              Email:


        Enrolled in the Occupational Health Program:             (Yes or No)
        Completed Required CITI Training:            (Yes or No)
        Briefly describe training plan or qualifications: [Tip: has been working with animals since 19XX…, Surgical skills include…]

        3                                                            Other Personnel
        List all personnel (other than PI) to be directly involved with the animals. Describe each person’s relevant training and
        experience, and indicate whether he or she (1) will serve as emergency contact for animal care issues and (2) be
        responsible for weekend/holiday/afterhours observation of animals.
                                                                   Role on Protocol:
         Name:                                                     (Post-Doc, Graduate Student, Undergraduate student, Lab Tech,
                                                                   Staff, Visiting Scholar, Affiliate, etc.)
                 (Yes or No) (1)will serve as emergency contact for animal care issues (Provide emergency phone #:         )
                 (Yes or No) (2) responsible for weekend/holiday/afterhours observation of animals
        Enrolled in the Occupational Health Program:             (Yes or No)
        Completed Required CITI Training:            (Yes or No)
        Briefly describe training plan or qualifications: [Tip: has been working with animals since 19XX…, Surgical skills include…]

                                                                 Role on Protocol:
        Name:                                                    (Post-Doc, Graduate Student, Undergraduate student, Lab Tech,
                                                                 Staff, Visiting Scholar, Affiliate, etc.)
                (Yes or No) (1)will serve as emergency contact for animal care issues (Provide emergency phone #:    )
                (Yes or No) (2) responsible for weekend/holiday/afterhours observation of animals




Georgia Institute of Technology                                                                                     IACUC@gatech.edu
Office of Research Integrity Assurance                                                                                   August 2012
IACUC Protocol Application                                                                                                    Page 3
 Enrolled in the Occupational Health Program:             (Yes or No)
 Completed Required CITI Training:            (Yes or No)
 Briefly describe training plan or qualifications: [Tip: has been working with animals since 19XX…, Surgical skills include…]

                                                           Role on Protocol:
 Name:                                                     (Post-Doc, Graduate Student, Undergraduate student, Lab Tech,
                                                           Staff, Visiting Scholar, Affiliate, etc.)
          (Yes or No) (1)will serve as emergency contact for animal care issues (Provide emergency phone #:    )
          (Yes or No) (2) responsible for weekend/holiday/afterhours observation of animals,
 Enrolled in the Occupational Health Program:             (Yes or No)
 Completed Required CITI Training:            (Yes or No)
 Briefly describe training plan or qualifications: [Tip: has been working with animals since 19XX…, Surgical skills include…]

                                                           Role on Protocol:
 Name:                                                     (Post-Doc, Graduate Student, Undergraduate student, Lab Tech,
                                                           Staff, Visiting Scholar, Affiliate, etc.)
          (Yes or No) (1)will serve as emergency contact for animal care issues (Provide emergency phone #:    )
          (Yes or No) (2) responsible for weekend/holiday/afterhours observation of animals,
 Enrolled in the Occupational Health Program:             (Yes or No)
 Completed Required CITI Training:            (Yes or No)
 Briefly describe training plan or qualifications: [Tip: has been working with animals since 19XX…, Surgical skills include…]

                                                           Role on Protocol:
 Name:                                                     (Post-Doc, Graduate Student, Undergraduate student, Lab Tech,
                                                           Staff, Visiting Scholar, Affiliate, etc.)
          (Yes or No) (1)will serve as emergency contact for animal care issues (Provide emergency phone #:    )
          (Yes or No) (2) responsible for weekend/holiday/afterhours observation of animals,
 Enrolled in the Occupational Health Program:             (Yes or No)
 Completed Required CITI Training:            (Yes or No)
 Briefly describe training plan or qualifications: [Tip: has been working with animals since 19XX…, Surgical skills include…]

 4       Veterinary Consultation
 Consistent with the Animal Welfare Act (AWA), Principal investigators must involve in their planning consultation with the
 Attending Veterinarian. You may contact Attending Veterinarian / Director of Animal Resources, Dr. Laura O’Farrell, at
 404.385.6233 or via email to: vet@gatech.edu.
 Date of Consultation:
 5       Study Objectives and Benefits to Society
 Briefly state the objectives of the study in lay terms and their relevance to advancing scientific knowledge and benefits to
 society (human/animal health). The answer should be written like a newspaper story about science or medicine using
 easily understood lay terms. Make minimal use of technical terms, and provide a brief explanation of any technical terms
 you must use. Routine use of acronyms is not appropriate. A scientific abstract from the funding application using highly
 technical terms is not acceptable. Note that scientific merit is not part of the evaluation of this proposal and that
 representatives of the general community who have no scientific background may be among the readers.

 6        Animal Species and Classification by Pain Level
 USDA Pain Classifications (see IACUC Policy 004 USDA Pain Categories for additional clarification).
 Class A: There is no direct contact with live animals. This includes observational field studies or use of cadavers not
 euthanized specifically for this study.
 Class B: This includes animals used for breeding or being held, but not directly used in research or teaching. Example:

Georgia Institute of Technology                                                                                  IACUC@gatech.edu
Office of Research Integrity Assurance                                                                                August 2012
IACUC Protocol Application                                                                                                 Page 2
 breeders and culls from breeding colonies. Breeding colony includes parents and offspring.
 Class C: Non-Painful/Non-Stressful: Animals upon which teaching, research, experiments, or tests will be conducted
 involving no pain, distress, or use of pain-relieving drugs. Example: routine procedures causing only slight or momentary
 discomfort such as venipuncture, injections, and the use of non-inflammatory adjuvants.
 Class D: Painful/Stressful WITH Analgesia, Anesthesia or Tranquilizers: Animals upon which experiments, teaching,
 research, surgery, or tests will be conducted that involve accompanying pain or distress to the animals and for which
 appropriate anesthetic, analgesia, or tranquilizing drugs will be used.
 Class E: Painful/Stressful WITHOUT Pain or Stress Relieving Measures: Animals upon which teaching, experiments,
 research, surgery, or tests will be conducted that involve accompanying pain or distress to the animals and for which the
 use of appropriate anesthetic, analgesic, or tranquilizing drugs would have adversely affected the procedures, results, or
 interpretation of the teaching, research, experiments, surgery, or tests.
 Species
 A current Scientific Collection Permit from the                                                  Total Number of Animals
                                                           USDA Pain Classification
 appropriate Fish & Game Department must                                                          for 3-Year Project Period
                                                           (A, B, C, D, or E)
 accompany the IACUC application for all wild caught                                              (including pups)
 animals*




 Why is it necessary to use this species for this purpose? [TIP: Explain in language that can be easily understood by a non-
 scientist.]
 If animals are listed in Class E, Painful/Stressful WITHOUT Pain or Stress Relieving Measures, provide references and
 scientific justification showing that all available or any particularly prescribed anesthetics, analgesics or tranquilizers will
 interfere with the specific measurements that are proposed in this protocol.

 7           Justification of Animal Numbers
 [TIP: If you have previously measured the parameters you propose to measure, then the number of animals per group
 needs to be justified using statistical power analysis. If you have no previous measurements, so state and indicate that the
 number of animals per group will be the minimum needed to obtain statistically significant differences between groups.
 The second part involves listing all your experimental groups with the number in each and the total at the bottom, which
 should add up to the total number of animals requested. ]

 [TIP: A power calculator for determining the number of animals per group, if applicable, may be found at
 http://www.stat.uiowa.edu/~rlenth/Power/index.html. Include a brief description of the statistical analyses, including
 tests, power and probability levels utilized, if applicable.]

 [TIP: Note: Scientific need should be used when possible to justify animal numbers rather than limitations of time,
 personnel, space, money, etc.]

 Justify the number of animals per group, if applicable




Georgia Institute of Technology                                                                                      IACUC@gatech.edu
Office of Research Integrity Assurance                                                                                    August 2012
IACUC Protocol Application                                                                                                     Page 3
 List and briefly justify the groups, if applicable, or otherwise justify the total animal numbers requested. Animals used
 for breeding must be included. The total number of animals must equal the number requested in the chart above.
 Make a list or flowchart or insert a table, if appropriate. The total number of animals must equal the total number of
 animals requested.


 8                                                Alternatives and Non-Duplication
 Perform sufficient database searches to verify that both unnecessary duplication will be avoided and that there are no
 alternatives to proposed painful and/or distressful procedures. Alternatives concern both replacement of animals and
 refinement of procedures so that they cause less pain and/or distress. Describe the searches in the following table:
                                                                                                       Keywords Used
                                                            Date limitations placed on the        (must include names of
    Databases Searched          Date of the Search
                                                                    search, if any                  painful or distressful
                                                                                                         procedures)




 Provide a written narrative of the sources consulted to determine whether or not alternatives exist to procedures that
 may cause pain or distress. For example: “Medline was searched on November 1, 2011 for alternatives to tailing a mouse,
 using keywords: genotyping, tailing, alternative, mouse, animal. No limits were placed on the search.” [TIP: Alternatives
 are anything that contributes to replacement, reduction, or refinement (the 3 R’s) of animal use with the goal of minimizing
 pain and distress. The Animal Welfare Information Center, a service of the National Agricultural Library established to
 provide information about alternatives, can be searched at http://www.nal.usda.gov/awic/. Examples of searches are
 available via Altweb http://altweb.jhsph.edu/.]

 Results of the database search:
         (YES, alternatives were found or NO, alternatives were Not found)
 If yes, explain why those alternatives cannot be used in lieu of the proposed procedures that may cause more pain or
 distress. (For example: “Alternatives to tailing were found, which include use of hair follicle, oral/anal epithelial swabs as
 sources of DNA. These methods, though possibly less painful/distressful, do not typically yield enough DNA for Southern
 Blot”).


    9                                                          Procedures
 Procedure location(s) (Building and room):


 Completely describe the planned procedures, including breeding and surgery.

 Describe the aseptic methods to be utilized.




Georgia Institute of Technology                                                                                    IACUC@gatech.edu
Office of Research Integrity Assurance                                                                                  August 2012
IACUC Protocol Application                                                                                                   Page 4
 Will more than one major survival surgery be performed on any animal? [TIP: Major survival surgery penetrates and
 exposes a body cavity or produces substantial impairment of physical or physiologic functions or involves extensive tissue
 dissection or transection (such as laparotomy, thoracotomy, craniotomy, joint replacement, or limb amputation). Insertion
 of needles, or placing subcutaneous implants is not considered major surgery.]
                  (Yes or No)
 If “Yes,” provide scientific justification for multiple major survival surgeries on the same animal. You must state why the
 research goal cannot be accomplished by performing the surgeries in separate animals.



 What is the training or experience of the people who will perform the procedures above?
 Procedure Summary: List or tabulate all the procedures that will be done to animals in each group in order making the
 time interval between clear, if applicable, so total life experience is summarized. [Tip: Recovery from prolonged, general
 anesthesia is normally limited to three times per week, per animal.]
 Example:
 Surgical Implantation Study
  Animals received and acclimatized for a minimum of 5 days
  Day 0              Surgery
  Day 12 +/- 5 days Anesthesia for blood collection, recovery
  Days 20-24         Restraint for once daily gavage
  Day 30             Anesthesia (3hrs) for imaging, recovery
  Day 42             Restraint for subcutaneous injection
  Day 62 +/- 2 days Terminal anesthesia for imaging, blood collection, euthanasia, tissue collection

 Describe post-procedural observation and care. Include:
      o Names of personnel responsible for monitoring / observing animals, including afterhours/weekends/holidays
      o Frequency of observation
      o Clinical signs you will observe to determine whether treatment is necessary
 [TIP: Animals must be monitored continuously until fully recovered from anesthesia and ambulatory]


   10                                             Summary: Administration of Materials
 List all materials including vehicles and diluents to be administered, applied, injected, implanted, etc. to animals including
 anesthetics, analgesics, fluids, euthanasia agents, paralyzing agents, etc.
                                                                                         Where
                                                                                     manufactured
      Species               Agent/Drug     Route     Dose (mg/kg) / Frequency                            Possible Complications
                                                                                      or obtained
                                                                                         from*




 *Tip: List the general type of manufacturing, not the particular company name i.e., drug company, compounding
 pharmacy, chemical company, manufactured in house, etc.
 Federal regulations require that pharmaceutical grade materials be used when available unless justified. Pharmaceutical
 grade is defined as materials approved by the Food and Drug Administration or for which a chemical purity standard has
 been established by the United States Pharmacopeia-National Formulary or British Pharmacopeia. Please list and provide
 justification for each non-pharmaceutical material that will be administered to living animals as a survival procedure.
 Please see IACUC Policy #002 for further clarification.


Georgia Institute of Technology                                                                                   IACUC@gatech.edu
Office of Research Integrity Assurance                                                                                 August 2012
IACUC Protocol Application                                                                                                  Page 5
 If non-pharmaceutical grade materials will be used, please address how adverse events related to grade, purity,
 cleanliness, sterility, pH, pyrogenicity, osmolality, stability, formulation, compatibility, etc. as applicable will be
 minimized.

 Who will perform the anesthesia? Describe each person’s training to perform the anesthesia procedures.


 11                                    Summary: Collection of Fluids, Tissue, Substances or Tail Collection
        Species                  Agent Collected       Volume Collected             Route                       Frequency




 12                        Infectious Agents, Biologics, X-rays/Radiation or Chemical Hazards, or rDNA Use
 Check if any of the following will be used, and specify each by name. Attach copies of approval emails or letters. [TIP:
 IACUC review will not be delayed by these parallel reviews. However, documentation of the appropriate approval(s)
 must be received by the ORIA prior to issuance of IACUC approval.]
 Does Protocol involve any of the following? (answer Yes or No for each)

 These require approval of the Institutional Biological Materials Safeguards Committee (BSMC):
 Does protocol involve Infectious Agents or Biologics?          (yes or no) If yes, list type:
 Does protocol involve Biological Hazards? List Type:          (yes or no) If yes, list type:
 Does protocol involve Hazardous Chemicals, including Chemical Carcinogens?                (yes or no) If yes, list type:

 These require approval of the Radiation Safety Committee (RSC):
 Does protocol involve Radioactive Materials?        (yes or no) If yes, list type:
 Does protocol involve X-rays/Radiation?        (yes or no) If yes, list type:

 If applicable, do you have BSMC or RSC approval for the materials indicated above?
          Not applicable
           Approval Pending
          Approval Attached - Protocol number:
 Does Protocol involve Recombinant DNA (rDNA) or Genetically Altered Materials?                   (yes or no)
 If yes, list all Recombinant DNA (rDNA) or Genetically Altered Materials:

 Institutional Biosafety Committee (IBC) approval is required for all rDNA.
 Materials above are approved under IBC Registration number:              (or note if approval is pending)
 Describe how personnel safety will be ensured. Specify the containment methods to be followed in protecting other
 research animals and personnel from any of the agents/hazards listed above. [TIP: If applicable, state how radioactive
 carcasses, cages and bedding will be handled]

 13                                                  Housing and Husbandry
 Where will animals be housed?
        Physiology Research Laboratory           (yes or no)
        If Not in PRL, state campus, building and room number:
 Provide justification for housing other than the PRL:




Georgia Institute of Technology                                                                                      IACUC@gatech.edu
Office of Research Integrity Assurance                                                                                    August 2012
IACUC Protocol Application                                                                                                     Page 6
 If animals will be moved between laboratories and housing, provide justification and state that animals will be
 transported in accordance with GIT Guidance on Transfer and Receipt of Animals. If there will be any exception from
 Policy 001, please describe and provide justification.
 14                                       Diet Manipulation / Environmental Modifications
 Unless indicated differently, all animals will be housed, fed and cared for according to legally mandated standards.
 Unusual diet or housing include:
          o need for autoclaving cages or deviation from the standard housing (wire-mesh floors must be justified)
          o special food or water, dietary / water manipulations (withholding of food or water, addition of drugs to
              food/water)
          o wearing of additional protective gear by the animal care staff (gloves and lab coat / scrubs are standard)
          o withholding of PRL standard enrichment devices
          o use of cages that are larger or smaller than the required minimums
          o use of running wheels, metabolism cages
          o individual housing of social species. If social animals are to be housed singly, provide scientific justification for
              single-housing. This does not apply to animals briefly housed singly post-operatively.
          o need for special light/dark cycles.
 Describe any non-standard diet, housing or environmental modifications, and how they will be accomplished. [TIP:
 Procedures that are specifically pre-operative should be described in Procedures below]


   15                                             Clinically Adverse Rodent Phenotype

 Will the study involve transgenic/knock-out/knock-in animals?              (Yes or No) (If no, skip to next section).

 If yes, is the strain being made in your lab or commercially available?
 If the phenotype is known, please describe any clinically adverse effects and what percentage of the offspring is
 affected. (i.e. seizures, skin ulcer, kidney failure, inflammatory bowel disease. If age effected, indicate whether it is
 present in homozygotes versus heterozygotes and what the morbidity/mortality is, etc.).
 If you expect any abnormalities to cause pain or distress, how will you minimize or alleviate it? Describe your
 monitoring and recording procedures for detecting physical or behavioral abnormalities which are indicative of pain or
 distress.


 16                                                          Tumor Studies
 Will the study involve tumors in animals?          (Yes or No) (If no, skip to next section).
 How will the tumors be produced?
 Naturally-occurring tumors          (Yes or No)
 Implanted tumors          (Yes or No)
 If Yes, please complete Section: Administration of Exogenous Substances and Section: Infectious Agents, Biological, X-
 rays/Radiation, or Chemical Toxin Use
      Type:
      *Source (include species):
      Site of Implantation or injection:

 Have the cell line(s) been tested for infectious agents?           (Yes or No)
 Will the size of the tumor exceed 1.5 in any dimension or 10% of the body weight of the animal? If Yes, provide written
 scientific justification:
    17                                             Euthanasia / Disposition of Animals



Georgia Institute of Technology                                                                                     IACUC@gatech.edu
Office of Research Integrity Assurance                                                                                   August 2012
IACUC Protocol Application                                                                                                    Page 7
 List early endpoints to the study otherwise known as euthanasia criteria. State the clinical signs that will indicate that an
 animal should be withdrawn from the study and euthanized. Unless otherwise noted it is assumed that meeting ANY ONE
 CRITERION listed below is an indication for euthanasia. For criteria such as weight loss or loss of appetite, include
 frequency of observation and measurement. [TIP: Rodents are usually dead before 20% weight loss occurs, unless it is a
 very gradual weight loss. For that reason, rodents with a 10% decrease from age-adjusted body weight should be
 withdrawn from the study and euthanized].


 Describe the method of euthanasia. Include agent and dose if applicable. Euthanasia shall be in accord with methods
 approved by the AVMA guidelines. [Tip: The AVMA Guidelines on Euthanasia can be found at
 www.avma.org/issues/animal_welfare/euthanasia.pdf . Physical methods of euthanasia (decapitation, thoracotomy,
 exsanguination, cervical dislocation) may be used when scientifically justified and generally only under general anesthesia.
 Carbon dioxide must be delivered from a compressed gas cylinder (no dry ice) and must be delivered very slowly to a
 chamber that has not been pre-filled.]


 If euthanasia is not the endpoint, specify the planned disposition of the animals. If animals are to be considered for
 adoption, so indicate here. [TIP: Wild caught animals may not be adopted without express written authorization from the
 Issuer of the Scientific Collection Permit. This documentation must accompany the IACUC application for review.]


                                           Required Protocol Submission Checklist:

 The following are required for all protocol applications submitted for consideration:
     Application signed below by PI (or submitted via GIT email by the PI)
     Application signed below by Chair/Dept Head/ Lab Director (or authorizing email sent to iacuc@gatech.edu)
     Copy of final grant pages
     All personnel completed CITI modules
     All personnel enrolled in Occupational Health
 The following are required if applicable:
     Copy of Scientific Collection Permit from the Fish & Game Department (Required for use of wild caught animals)
     Approval emails or letters from Institutional Biological Materials Safeguards Committee or Radiation Safety Committee
 (Required for proposed use of infectious agents, biological hazards, hazardous chemicals, carcinogens, radioactive
 materials, or X-rays/radiation)
     Approval letters from Institutional Biosafety Committee (Required if use of rDNA is proposed)
                                    Submit this application and all attachments via email to:
                                                     iacuc@gatech.edu

                       Use of GA Tech email accounts (.gatech.edu) is required when submitting protocols.
                         Office of Research Integrity Assurance http://www.researchintegrity.gatech.edu
                                                        Certifications and Signatures
 Certification: I will comply with the procedures and methods described in the NIH Guide for the Care and Use of
 Laboratory Animals (Pub. 85-23), with PHS policy, the Animal Welfare Act, the Georgia Institute of Technology Animal
 Welfare Assurance A-3822-01, and other applicable Institute policies.

 Certification: I assure that the activities involving vertebrate animals as described in this application do not unnecessarily
 duplicate previous experiments.

 Certification: I assure that the animal use proposed in a grant or contract proposal to support this research corresponds
 with the information provided herein (if applicable).

 Certification: As Principal Investigator, I acknowledge responsibility for this project and assure that the personnel who

Georgia Institute of Technology                                                                                   IACUC@gatech.edu
Office of Research Integrity Assurance                                                                                 August 2012
IACUC Protocol Application                                                                                                  Page 8
 participate in it are qualified and adequately trained to conduct it in a humane manner.

 In lieu of a written signature, PI may submit protocol application via e-mail to iacuc@gatech.edu from your GT email
 account.

 Date:            Principal Investigator Signature ________________________(or submit via GIT email for electronic signature)

 Departmental sign off:
 I have reviewed this IACUC Application and related research plans and concur with their submission to the Institutional
 Animal Care and Use Committee for review.

 Date:            Department Chair Signature ________________________(or submit via GIT email for electronic signature)


  In lieu of dept head signatures, the Office of Research Integrity Assurance will accept an email from the dept head, sent
                         to IACUC@gatech.edu, in which the department head states something like:

                 “I have reviewed this IACUC Protocol and related research plans and concur with their submission
                                 to the Institutional Animal Care and Use Committee for review.”




Georgia Institute of Technology                                                                                IACUC@gatech.edu
Office of Research Integrity Assurance                                                                              August 2012
IACUC Protocol Application                                                                                               Page 9

				
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