The University of Texas at El Paso s6

The University of Texas at El Paso Animal Care and Use Committee **Below for IACUC Office Use** CHANGE IN PERSONNEL Date Received: AMENDMENT REQUEST FORM Date Approved:

Logged: ______Database: ______

Protocol No: Principal Investigator (s): Project Title: Department(s): Telephone: Fax: Email: List any attachments here:

 Please use this form to add personnel except Principal Investigator. Mail, bring, or fax (915-747-6063) a signed copy of this form to the IACUC Office, Burges Hall, Room 403.

 Forms will be processed administratively as received. Full committee review is not mandatory.

 Each individual must complete Basic Laboratory Safety, Biosafety/Bloodborne Pathogens, and the AALAS online training courses before the individual will be approved to handle animals under this protocol and before this amendment can be processed. Safety Trainings can be arranged through the Environmental Health and Safety Office (915-747-7124). The course description outlining the animal care and use training is posted at: http://research.utep.edu/Portals/99/Doc/aalas%20login%203.doc For further explanation regarding the online training, please contact the IACUC Office at 915-747-6355.

 Each individual must be enrolled in The University’s Occupational Health Program (OHP) before the individual will be approved to handle animals under this protocol and before this amendment can be processed. The Student Health Center can be reached at 915-747-5624/2470, or visit http://research.utep.edu/Default.aspx?tabid=39518.

Please address the following information for each person listed: 1 - Degree(s) held and any board certifications or specialty training pertinent to the protocol. 2 - List procedures each person may be performing if playing a limited role or state “all.” 3 - Describe person’s experience (with animal models) in the specific procedures they will perform under this protocol. 4 - State who will be supervising and training personnel who are not yet qualified to perform procedures independently.

1) I understand that the personnel to be added must not begin work on this protocol until approval is received from the Animal Care and Use Committee.

2) The personnel to be added are fully qualified to perform animal related duties under this protocol or will be trained and supervised by the Principal Investigator named above and will be given a copy of the protocol.

PI Signature: Date:

IACUC Authorized Approval: Date:

New Form 09/2006, Updated 07/2007 Personnel Amendment Form, Page 1 Role: New Primary Co-investigator (person delegated authority when PI is unavailable) Last Name: First Name: M. Initial: UTEP ID #: Department: School: UTEP Address: Bldg: Room: Office Phone: Fax: E-mail: UTEP appointment or job title: Address questions 1-4: IACUC Office use: OHP ______AALAS ______BLS ______Biosafety/BBP ______

Role: Co-Investigator Fellow Student Faculty Staff Outside Collaborator (Check all that apply.) Last Name: First Name: M. Initial: UTEP ID #: Department: Phone Number: UTEP Address: Bldg & Room: Email Address: UTEP appointment or job title: Address questions 1-4: IACUC Office use: OHP ______AALAS ______BLS ______Biosafety/BBP ______

New Form 09/2006, Updated 07/2007 Personnel Amendment Form, Page 2 A-______