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California State University, Long Beach
Office of University Research
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Request for Modification of an Approved Project

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Instructions: During the conduct of an approved project it may become necessary to modify or deviate from the approved protocol. Such changes must be communicated to the IACUC for approval prior to the implementation of the change by use of the Request for Modification of an Approved Protocol Using Animal Subjects (see form, below).

The form must be typed. Please answer each question using as much additional space as necessary.

Process:

  • The Request for Modification of an Approved Protocol Using Animal Subjects must be typed and submitted to the Attending Veterinarian either by e-mail (john.young@cshs.org) or by fax (310-423-0290) and the Office of University Research (iacuc@csulb.edu), fax (562-985-8665).
  • The Veterinarian will either forward the Request for Modification to the IACUC Chair with approval and comments or return it to the applicant for change.
  • When the Chair and the Veterinarian both approve, the Chair will send the approved Modification to the Office of University Research indicating approval.

Notes:

Request for Modification of a Currently Approved Project

Name of Principal Investigator:
Title of Project as Approved:
IACUC Number Assigned:
  1. Briefly summarize the proposed modification to the previously approved application.
    • If you are requesting a modification to Personnel, Surgical Procedures (including Anesthesia), Non-surgical Procedures, Euthanasia, or Animal Numbers, please include all information requested in the appropriate sections of the full Application. You may copy out of the Application for Use of Animal Subjects the appropriate sections, complete them, and insert them here.
  2. Does this modification reflect a change of scope or objective in your research? (y/n)
    • If yes, please note that IACUC approval of this Request for Modification does not constitute approval of an external funding agency, nor of the college or University with respect to facilities, equipment, etc. If this project is externally funded, your funding agency may require that you submit the modification for approval at the agency.
Signature of Principal Investigator and Date:

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