Anne Londregan
  
Principal Investigator Form
First Name  
Last Name  
Submitted Date 01/21/2022  
Job Title  
Campus Key  
Campus Email  
Building  
Department  
Phone  
Lab Number  
Animal Housing Location(s)
 
Species


Describe your academic training, credentials, (e.g. degrees, AALAS certifications) and previous experience in animal research activities.
Briefly describe your role in animal activities related to the protocol(s). Before submitting this form please verify the listed animal activities with your lab manager or PI to see if they are accurate.
Please indicate what animal procedures you will be performing and any other specific technical training you would like to receive.
List below all IACUC protocol numbers this person will be working on or associated with.
List below all animal activities that this person will be trained in by the PI or his/her support personnel.
Please check this box if your trainee will be working with any biohazards. If so they will need to contact Sue Gotta for Biosafety Training  
Trainee Electronic Signature  

By signing below and submitting this form, as Principal Investigator, I certify that the above named individual has adequate training or will receive the appropriate training necessary to qualify him/her to perform the assigned animal activities related to my protocol(s). I understand that I am responsible for providing and documenting any and all training that is not already provided by Laboratory Animal Services (LAS) or the Veterinary Staff.

Principal Investigator Electronic Signature Date of PI Signature
Principal Investigator
 
Please use your Campus Key as your Electronic Signature. For Office Use Only