IACUC Inter-institutional agreement

This Inter-institutional Agreement provides assurance that the collaborative animal use has received Institutional Animal Care and Use Committee (IACUC) review and specifies who is responsible for animal husbandry and care.

Name of collaborating institution providing IACUC review (collaborating institution)(Required)

Collaborating institution USDA registration number(Required)

Collaborating Institution Animal Welfare Assurance (AWA) number(Required)

AAALAC accreditation status(Required)

The Officials signing below agree that Northern Arizona University may rely on the designated IACUC of (the collaborating institution) for the review and continuing oversight of its research involving animals described below

This agreement covers the following specific protocol(s)

Name of research project (grant/contract title)(Required)

Name of Principal Investigator(Required)

Sponsor or funding agency (if applicable)

Sponsor’s award number (if applicable)

IACUC protocol title(Required)

IACUC protocol approval number(Required)

IACUC protocol approval date(Required)

Fill out all animal care fields that apply.

Ownership of the animals is the responsibility of(Required)

Purchasing/Acquisition of animals is the responsibility of(Required)

Payment for animal care and procedures is the responsibility of(Required)

The animals will be housed at(Required)

Provision of animal housing, daily husbandry, and veterinary care is the responsibility of(Required)

If NAU representatives are directly participating in the work involving live vertebrate animals, NAU will provide occupational health training (up to ABSL2/BSL3) and the Collaborating Institution will provide any additional training that is unique to mitigating risk in their facility/research program.

Any additional information (describe):

Attach documents

Official documentation of approval by the IACUC

Drop files here or

Max. file size: 20 MB.

The NAU IACUC requests that the collaborating institution provide, as applicable:

– Documentation of IACUC approval for modifications to the approved protocol as well as triennial reviews of the protocols.

– Notification of review and reporting of any incidents of non-compliance with PHS Policy, the Guide for the Care and Use of Laboratory Animals, or any suspension of this activity by the IACUC

– Additionally, NAU requests that the collaborating institution provide notification of change in PHS Assurance status or AAALAC International Accreditation status

Northern Arizona University remains responsible for ensuring compliance with the IACUC’s determinations and with the Terms of its OLAW-approved Animal Welfare Assurance. This document must be kept on file by both parties and provided to OLAW upon request. Completion of this document provides assurance that the review performed by the Collaborating Institution’s IACUC meets animal welfare requirements prescribed in the institution’s OLAW-approved Animal Welfare Assurance.

Name and title of official collaborating institution(Required)

Signature(Required)

By checking this box, I certify that, to the best of my knowledge, the information included herein is accurate and complete.

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