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UW Oshkosh
Office of Sponsored Programs and Faculty Development
IACUC Animal Number Increase Form
This form requests an increase in animal use numbers relative to a previously approved animal use protocol.
Note: To request an increase in > than 20% of the original number approved please submit a modification
request for formal IACUC review.
Date This Form Submitted:
Protocol #:
Protocol Title:
Principal Investigator (PI):
Species
Original number approved
Increased number
Please provide justification for your request (use all the space you need) and indicate if pain category
will be changed:
By checking this box and signing below, I understand that any failure to comply with the guidelines and
requirements of the IACUC may result in suspension of my studies and notification to the funding agency, the
OLAW, and/or the USDA as mandated by law.
Signature of PI:
Date:
Signature: An electronic signature is acceptable when submitting to iacuc@uwosh.edu. Submit form using
your UW Oshkosh email account for user verification.
--------------------------------------------------------------------------------------------------------------------------------------------------IACUC Use Only below this line
Rational for the increase in animal numbers to be used was provided
The requested change(s) are:
Approved.
Referred back to the PI for conversion to a Protocol Modification Request Form, followed by formal IACUC
review.
Comments :
Signature :
Date:
Form Adopted: 10/8/2014 Location: S:IACUCAdministration/IACUCFormsandDocuments/FormsforIACUCSubmission/CurrentDocuments
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UW Oshkosh
Office of Sponsored Programs and Faculty Development
IACUC Compliance Officer
Animal space availability has been verified by Laboratory Animal Manager if animals are housed in ACF.
Signature :
Date:
Laboratory Animal Manager
Form Adopted: 10/8/2014 Location: S:IACUCAdministration/IACUCFormsandDocuments/FormsforIACUCSubmission/CurrentDocuments
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