REQUEST FOR WAIVER OF IACUC APPROVAL FORM INSTITUTIONAL ANIMAL CARE & USE COMMITTEE Please complete and submit this form to IACUC to determine if a project needs IACUC approval Examples of projects which may be waived are: observational animal use (no manipulation of the animal or animals, animal behavior, or habitat) and animal specimen use (e.g., blood, feces, urine, tissues, secretions, cells, etc.) Return completed forms to: Office of Research Administration, Carrington 407 *Fax: 417-836-8818 *Email: IACUC@missouristate.edu *If you submit this document electronically, you must send a scan of the hand signed copy Office Use Only Submission Number: Notice of Review sent: Section Personnel Information A Principal Investigator Contact Information Principal Investigator: Department: Office Phone: Emergency Phone: B Personnel Qualifications and Training Information Office Address: Email: List all individuals, including Principal Investigator, working on the project Note: Training should indicate both online training modules and lab-specific procedures Experience should indicate length of involvement (months, years, etc.) in the relevant area of research Name Section Project Information A Project Title B Project Duration C Project Summary Title/Position Degree Training/Experience Provide, in terms comprehensible to a nonscientist, the general objectives of the project Specifically, state the hypothesis for this project and explain the experimental design and methodology If you are conducting an observational study, please make sure to detail species, location, experiment, and final disposition If you are using animal specimens, please make sure to detail specimen type, acquisition, experiment, and disposal D Justification For IACUC Approval Waiver Section Investigator Assurances The information provided herein is accurate and, to the best of my knowledge, conforms to all applicable University, PHS, and USDA policies on the use of animals in research and teaching I agree not to proceed with any portion of this project until I receive written notice of review from the Missouri State University Office of Research Administration Signature of Principal Investigator: Date: