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April 2009 version
Southeastern Louisiana University
Institutional Animal Care and Use Committee
Protocol Annual Update / Amendment / Extension Form
Protocol Title:
Primary Investigator:
IACUC Protocol#:
1. This form is being used for: (Check all that apply.)
Annual Update (e.g., yearly collection permits/licenses)
Protocol Amendment (minor change in existing project/experiment)
Protocol Addition (addition of new project/experiment to existing protocol; if new project is extensive,
IACUC may request a new protocol.)
Extension of Protocol termination date (6 month maximum)
2. Review original protocol and explain changes in the categories checked below: (Note: As part of this process,
IACUC will review the original protocol and, if substantial changes are noted, IACUC may require submission
of a new protocol.)
There have been no changes.
Changes in named personnel.
Persons deleted:
Persons added:
Answer the following for each individual added:
a. Person has completed animal on line-training and quiz. Yes No
b. Procedure(s) this person will perform:
c. Species on which this person will perform stated procedure(s):
d. How was (will) this individual (be) trained to do the procedure(s)?
e. Who (will) provide(d) the training?
f. Qualifications of this person to perform the procedure(s) and provide training?
(Years previous experience and training)