SARL at Oregon State University

Notes: All fields with * must be completed before you submit the form.

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Instructions for completing the "Name of the Request” field: Enter any request name or code in this field (must contain 2 digits, and not exceed 10 characters total). You will need to remember this name or code to update your request in the future.

Name of the Request: (Request should be unique for each protocol).

Date:

Experiment Number:

*Researcher:

*Researcher's Email Address:

*Principal Investigator:

*Experiment Title:

*IACUC Approval #:

Background (Optional):

*Purpose:

Significance:

*Test Compound: (Hold Ctrl to choose multiple options.)

If "Other" chosen for "Test Compound" describe here.

*Chemopreventative Agents: (Hold Ctrl to choose multiple options.)

If "Other" chosen for "Chemopreventative Agents" describe here.

*Route of Exposure:

*Research Animal:

*Experimental Details: (You can cut and copy the contents for this option in any format.)

*Care and Feeding Instructions:

Any other notes to SARL Facility (Optional):

Important dates:(Cut and Paste your contents in this text area).

Summary of Experimental design :

*Total number of tanks:

*Total number of fish: (enter only digits)

*Age or size of fish:

*Estimated start date: (yyyy/mm/dd) format.

*Ending date: (yyyy/mm/dd) format.

*Safety considerations and instructions:

*Decontamination of liquid waste:

* Agreement to acknowledge NIH Funding.
I agree to acknowledge NIH/NIEHS for their support of the aquatic research facility by including the following grants numbers in any publication resulting from this request. NIH/NIEHS grants #ES00210, and #ES03850.