University of Southern California by K7ox31


									                               University of Southern California
                        Institutional Animal Care and Use Committee
                                  Stipend/Fellowship Form
                For Stipend/Fellowship and Program Project/Core Grants
(Please fill out all fields on this form accurately and completely. Print the completed form, sign and return to
                                            the Animal Resources office)

Instructions: Use this form for approval of grants that may have animal components, but
where no animals are to be ordered on the grant directly. The principal investigator(s) and
IACUC approval number(s) should be listed below for all animal studies associated with
this grant.

PI. Last Name:                          First Name:                              Protocol No:

Department:                             Campus Address:                          Phone:

Title of Protocol:

Funding Agency:                                Type of Protocol:      Stipend/Fellowship      Program

PI Name:                IACUC Approval Number:                   Title:

Principal Investigator Assurance: I agree to abide by the Guide for the Care and Use of
Laboratory Animals, the USDA Animal Welfare Regulations (CFR 1985) and Public Health
Service Policy on Humane Care and Use of Laboratory Animals (1996). I have reviewed and
agree to abide by all institutional policies governing the use of vertebrate animals for research,
testing, teaching or demonstration purposes at USC. I certify that the proposed studies do not
represent unnecessary duplication of experiments. I also certify that in the event that animals in
this study experience pain or distress which cannot be adequately relieved, I will euthanize those
animals immediately based on recommendations of the Animal Resources veterinary staff or

                _______________________________                   _____________________
                 Signature of Project Director                          Date

                _______________________________                   _____________________
                        Approved by IACUC                               Date

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