ࡱ> SpRO ,-bjbj3O3O *2Q%eQ%eJ+ O.O.O.O.O.c.c.c.8.<.,c.8h//////// 0 0 08888888$;=689O. 0 0 0 0 068O.O.////o8d1d1d1 0FO.//O.//8d1 08d1d1n6\7//;3P0F7 7808<7 u>0du>@\7u>O.\7 0 0d1 0 0 0 0 068680j 0 0 08 0 0 0 0u> 0 0 0 0 0 0 0 0 0 -: Revised 03/2020 鶹ý INSTITUTIONAL ANIMAL CARE AND USE COMMITTEE (IACUC) STUDENT RESEARCH ASSISTANT TRAINING CERTIFICATION This form must be completed by all students (undergraduate and graduate) prior to their involvement in any animal research protocol. A separate form is required for each student and each animal research protocol in which the student participates. The form must be co-signed by the Faculty Advisor and the Animal Caretaker. Protocol # _________________ Faculty Investigator: ____________________________________ (List only ONE protocol per form) Research Assistant: _____________________________________ Title of the Protocol: __________________________________________________________________ (List FULL TITLE of protocol) SECTION I. STUDENT or INVESTIGATOR CERTIFICATION: I am a: % Student Researcher (Sections I-V must be completed) % Faculty Investigator I hereby certify that I (please check off when completed): __ have read the animal research protocol listed above __ have completed CITI Lab Animal Welfare Training ( HYPERLINK "http://www.citiprogram.org" www.citiprogram.org; attach completion report) __ have familiarized myself with the contents of the Tutorial on the Public Health Service Policy on Humane Care and Use of Laboratory Animals found at http://grants.nih.gov/grants/olaw/tutorial/index.htm __ have received complete training from the Animal Caretaker in the maintenance procedures of the Animal Facility. __ will not perform animal research without direct supervision until I receive proper training and can competently perform the appropriate procedures (STUDENT ONLY; Complete Training in Techniques) ______________________________ ______________________________ __________________ _________________________________ ________________________________________ _________________ Signature of Student or Investigator Printed Name of Student or Investigator Date SECTION II. ANIMAL CARETAKER CERTIFICATION: I hereby certify that ________________________________, a student who will be working on the animal (Printed Name of Student) protocol listed above, has received training in the maintenance procedures of the _____________________ Animal Facility. _____________________________ ________________ Signature of Animal Caretaker Date SECTION III. TRAINER CERTIFICATION: I hereby certify that ______________________________ has received full training on the following dates: ___________________________________, and has demonstrated competence to perform the following surgical techniques and/or specialized husbandry procedure without direct supervision: SECTION IV. FACULTY INVESTIGATOR CERTIFICATION: I hereby certify that ________________________________, a student who will be working on the animal (Printed Name of Student) protocol listed above, has read the research protocol, watched the videotapes, familiarized him/herself with the PHS Policy Tutorial, and received training from the Animal Caretaker. I further certify that this student will not perform animal research without direct supervision until s/he is properly trained and can competently perform the appropriate procedures. ______________________________ ___________________ Signature of Faculty Investigator Date SECTION V. ANIMAL FACILITIES DIRECTOR APPROVAL: (]^   ' 6 X Y k  лyk^Qh*5>*䴳ϴ5>*䴳ϴ!=!=5Cϴa5Cϴ*CJh*56CJ h}CJh*5OJQJ h*CJh*6CJ]hhC=6CJ]'(\]^ 6 X Y  ? @ ( jgd{$a$$a$ 0 = ? @ O   * D t v x ( H ǸѤǮ~sh]h]h]RGRh$5CJOJQJh+5CJOJQJh{5CJOJQJh*5CJOJQJhhC=5CJOJQJh25CJOJQJh2h2CJOJQJaJh2CJ,OJQJaJ,hVoCJOJQJh*CJOJQJh2h2CJ,OJQJaJ,h2CJOJQJhhC=CJOJQJh*5CJOJQJh*5>*CJOJQJh25>*CJOJQJ89:MNPhijs FGP1BQr崩vhaZaZS h25CJ h*5CJ h{5CJhxQh*>*CJOJQJhxQhxQ>*CJOJQJh{56CJOJQJh*56CJOJQJh*5CJOJQJh+5CJOJQJh{5CJOJQJh2;h$0J[5CJOJQJ*jh2;h$5CJOJQJUh$5CJOJQJjh$5CJOJQJUj G5  zfgdVo^gd2h^hgd{r~ zef:<Ażżۥ{rkgc_chhC=hVoh* hVo5>* h5>* hhC=5>* h* h2h*h*56CJh256CJh* h5>* hVo5>* h#n?5>* h45CJh4h45CJh4hqG5CJ hhC=5>* hqG5>*h* h*5hVo56CJh*56CJhVoh*>* hVo>*hVohVo>*hVo ha>*&./0123456789:;<Hl`gdVolm_`a------ - -gd ^`^_,,,,G,P,m,r,{,------ - - - -$-%-&-ƽƽxtxtxtxtlhl_h0mHnHuhrjhrUhzjhzUh#n?hqG56CJaJh#n?56CJaJhqGhqG6CJaJ hqGaJ hqG>*aJUh5>*aJhqG5>*aJh#n?5>*aJhh5CJhhC=56CJh56CJh*56CJh* h*5CJ!___________________________ ______________________ _______________ ___ Signature of Director Printed Name of Director Date      PAGE \* MERGEFORMAT 1 - -(-)-*-+-,-gd$a$&-'-)-*-+-,-h#n?hqG56CJaJhzhXhrjhrUmHnHu(/ =!"#$h%hh DyK www.citiprogram.orgyK 8http://www.citiprogram.org/dw666666666vvvvvvvvv66666686666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@6666_HmH nH sH tH D`D NormalCJOJQJ_HmH sH tH L@L  Heading 1$$@&a$5>*CJOJQJ\\  Heading 2$<@& 56CJOJQJ\]^JaJVV  Heading 3$<@&5CJOJQJ\^JaJRR  Heading 4$<@&5CJOJQJ\aJNN  Heading 5 <@&56CJ\]aJPP  Heading 6 <@&5CJOJQJ\aJFF  Heading 7 <@& OJQJaJLL  Heading 8 <@&6OJQJ]aJN N  Heading 9 <@&CJOJQJ^JaJDA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List \$\ Envelope Address!@ &+D/^@ <>@< Title$a$5CJOJQJ:B@: Body Text CJOJQJ4"4 Header  !4 @24 \0Footer  !\CB\ Body Text Indent^`5CJOJQJDTRD Block Textx]^<Pb< Body Text 2 dx>Qr> Body Text 3xCJaJ`M` Body Text First Indentx` CJOJQJpNAp Body Text First Indent 2hx^h`5CJOJQJRRR Body Text Indent 2hdx^hTST Body Text Indent 3hx^hCJaJ<"< Caption xx 5CJ\2?2 Closing ^88 _ Comment TextCJ$L$ DateRYR  Document Map -D M OJQJ^J<[< E-mail Signature!8+"8  Endnote Text"CJJ%2J Envelope Return#CJOJQJ^J:B:  Footnote Text$CJ:`R: HTML Address%6]NebN HTML Preformatted&CJOJQJ^J: : Index 1'^`: : Index 2(^`: : Index 3)^`: : Index 4*^`:: Index 5+^`:: Index 6,^`:: Index 7-^`:: Index 8.^`:: Index 9/p^p`H!rH  Index Heading05OJQJ\^J4/4 List1h^h`82"8 List 22^`8328 List 338^8`84B8 List 44^`85R8 List 55^`:0b: List Bullet 6 & F>6r> List Bullet 2 7 & F>7> List Bullet 3 8 & F>8> List Bullet 4 9 & F>9> List Bullet 5 : & FBDB List Continue;hx^hFEF List Continue 2<x^FFF List Continue 3=8x^8FGF List Continue 4>x^FHF List Continue 5?x^:1: List Number @ & F >:> List Number 2 A & F >;"> List Number 3 B & F ><2> List Number 4 C & F >=B> List Number 5 D & F l- Rl  Macro Text"E  ` @ OJQJ^J_HmH sH tH Ib Message HeadergF8$d%d&d'd-DM NOPQ^8`OJQJ^JaJ@^r@ Normal (Web)G OJQJaJ>> Normal Indent H^4O4 Note HeadingI@Z@ Plain TextJCJOJQJ^J0K0 SalutationK6@6 Signature L^JJJ SubtitleM$<@&a$OJQJ^JaJT,T Table of AuthoritiesN^`L#L Table of FiguresO ^` L.L  TOA HeadingPx5OJQJ\^JaJ&& TOC 1Q.. TOC 2 R^.. TOC 3 S^.. TOC 4 T^.. TOC 5 U^.. TOC 6 V^.. TOC 7 W^.. TOC 8 X^.. TOC 9 Y^FV F  FollowedHyperlink >*B* ph6U`6 $ Hyperlink >*B*ph:/: r0 Footer Char CJOJQJB' B a0Comment ReferenceCJaJ@j@ `a0Comment Subject^5\B/B aComment Text CharOJQJN/N ^a0Comment Subject Char5OJQJ\DD ba0 Balloon TextaCJOJQJaJB/!B aa0Balloon Text CharCJaJH 2H0RevisioncCJOJQJ_HmH sH tH PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭VGRU1a$N% ʣꂣKЛjVkUDRKQj/dR*SxMPsʧJ5$4vq^WCʽ D{>̳`3REB=꽻Ut Qy@֐\.X7<:+& 0h @>nƭBVqu ѡ{5kP?O&Cנ Aw0kPo۵(h[5($=CVs]mY2zw`nKDC]j%KXK 'P@$I=Y%C%gx'$!V(ekڤք'Qt!x7xbJ7 o߼W_y|nʒ;Fido/_1z/L?>o_;9:33`=—S,FĔ觑@)R8elmEv|!ո/,Ә%qh|'1:`ij.̳u'k CZ^WcK0'E8S߱sˮdΙ`K}A"NșM1I/AeހQתGF@A~eh-QR9C 5 ~d"9 0exp<^!͸~J7䒜t L䈝c\)Ic8E&]Sf~@Aw?'r3Ȱ&2@7k}̬naWJ}N1XGVh`L%Z`=`VKb*X=z%"sI<&n| .qc:?7/N<Z*`]u-]e|aѸ¾|mH{m3CԚ .ÕnAr)[;-ݑ$$`:Ʊ>NVl%kv:Ns _OuCX=mO4m's߸d|0n;pt2e}:zOrgI( 'B='8\L`"Ǚ 4F+8JI$rՑVLvVxNN";fVYx-,JfV<+k>hP!aLfh:HHX WQXt,:JU{,Z BpB)sֻڙӇiE4(=U\.O. +x"aMB[F7x"ytѫиK-zz>F>75eo5C9Z%c7ܼ%6M2ˊ 9B" N "1(IzZ~>Yr]H+9pd\4n(Kg\V$=]B,lוDA=eX)Ly5ot e㈮bW3gp : j$/g*QjZTa!e9#i5*j5ö fE`514g{7vnO(^ ,j~V9;kvv"adV݊oTAn7jah+y^@ARhW.GMuO "/e5[s󿬅`Z'WfPt~f}kA'0z|>ܙ|Uw{@՘tAm'`4T֠2j ۣhvWwA9 ZNU+Awvhv36V`^PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!g theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] v2 ***- rA&-,- jl -,- _vX $&-!8@0(  B S  ?JLMOPRSUVtwJLMOPRSUVtw vvIJVqw vvIJVqtw |BUD}ئz]C~XSBBAt@:(`d92M8>hV7N@(&Z6M LJ i9m[ ^`.^`.88^8`.^`. ^`OJQJo( ^`OJQJo( 88^8`OJQJo( ^`OJQJo(hh^h`. hh^h`OJQJo(hh^h`CJOJQJo(q hh^h`OJQJo(hh^h`CJOJQJo(q LJMi9m[~}| "! 2+>@%*=!==#?"qFφ?/ˑ?@ACDEFGHIKLMNOPQTUVXYZ[\]^_`abcdefghijklmnorstRoot Entry F3qData 1Table">WordDocument *2SummaryInformation(BDocumentSummaryInformation8JMsoDataStore2;3CXODUWG5JUC0==2 2;3Item  Wk0Properties}MCO2U5L2KWA==2 2;3Item  PropertiesOCompObjr This value indicates the number of saves or revisions. The application is responsible for updating this value after each revision.   DocumentLibraryFormDocumentLibraryFormDocumentLibraryForm   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q