Department
Protocol Number
Protocol Title
New PI
Title
Department
Explain the reason for change in PI:
Is the new PI currently listed as personnel on the protocol? ☐No ☐Yes
Will the current PI remain on the protocol as personnel? ☐No ☐Yes
Will there be any changes to the experimental plan? ☐No ☐Yes
If No, the protocol will maintain its original date of approval and protocol number. Continue with submission of this form only.
If Yes, the protocol must be rewritten and submitted by the identified PI. Upon completion of review and approval, the protocol will receive a new approval date and number.
What is the funding source for this protocol?
*Departmental funding requires approval by Department Chair.
Change of Principal Investigator is considered a major protocol change and must be reviewed by the committee at a convened meeting.
The IACUC reserves the right to request a complete resubmission of the protocol at any time.
Signature of Current PI
“My signature denotes transfer the above listed protocol to the identified new PI.”
X______
Signature of Current PI (Paste digital copy of signature)
Signature of New PI
“I have read the above named protocol and I am familiar with the experiments and procedures described in the protocol. My signature certifies that as Principal Investigator, I will conduct the project in full accordance with the PHS Policy on Humane Care and Use of Laboratory Animals, USDA regulations, and UMMC policies governing the use of live vertebrate animals for research and teaching purposes. The procedures involving animals will be conducted by trained or experienced personnel or under the direct supervision of trained or experienced persons. The PI understands that changes MUST NOT be implemented until IACUC approval has been granted.”
X______
Signature of New PI (Paste digital copy of signature)
*Approval by Department Chair (only required for departmentally funded studies)
“I have read this request for change in Principal Investigator and find that the investigator is qualified to perform (or supervise) this study. My signature below denotes departmental approval and support of this study as submitted.”
X______
Department Chair (Paste digital copy of signature)
Approval by the Institutional Animal Care and Use Committee:
X______
Signature of IACUC Chair or Designee
2016