Tissue Collection and Use Protocol in Rodents Application Form
Instructions: If applicable, submit this Form with the IACUC Animal Use Protocol (AUP)
1. Administrative Information
Academic Rank:
Faculty:
Department:
4. How the tissue samples will be collected?
5. How the tissue samples will be fixed or prepared for use?
6. How the tissue samples will be used?
7. What is the number of tissue samples that will be collected from each animal?
8. What is the proposed number of animals to be used for tissue collection?
9. Will any manipulations of live animals (such as special diet, dietary changes, food or water restriction, or hormonal treatment) be performed prior to tissue collection?
10. Will the tissue samples be transported outside the University facilities?
11. Will the animals be restrained prior to the tissue collection procedure?
12. Will the animals be anesthetized prior to the tissue collection procedure?
13. Will the animals be euthanized immediately following tissue collection?
14. List all personnel contacting the animal tissues
15. Experience and Training of the investigator(s)