IACUC Certification Class Registration Form

Only fill out this form once!  All information at the beginning of this form must be filled out completely.

Employee or Student ID number  NOT Cat Card - no dashes

Provide SID  if you took UA IACUC classes as a student before becoming an employee & IACUC number  

Last Name:      First Name:     MI:

Email address:  Required

Department: Choose One Aero & Mech Eng Ag BioSys Eng Anesthesiology Animal Care-Other Animal Care-BSS Animal Care-Husbandry Animal Science Anthropology AZ Arthritis Center Az Res Lab Basic Sciences COM PHX Biochemistry Biomed Engineering Cancer Center Cardiology Cell Bio/Anatomy Chemistry Cognitive Science Col of Medicine Col of Nursing Col of Pharmacy Col of Pub Health CT Surgery Dermatology Ecol & Evol Bio Elec Comp Eng Emergency Med Endocrinology Entomology Envir Res Lab Fac Mngmt Gastroenterology Geriatrics Heart Ctr Imarx Infectious Disease Liver Research Maricopa Ag Ctr Micro/Immuno Mol & Cell Bio Neural Systems Neurology Neurosurgery Nutritional Science Ob/Gyn Ophthalmology Orthopedics Pathology Pediatrics Pharm/Tox Pharmacology Pharmacy Science Physiology Plant Pathology Plant Science Protein Therapeutics Psychology Rad/Onc Radiology Renal Renew Nat Res Respiratory Science Sebra Steward Observatory Surgery Surgery CRC Surgery ENT Surgical Biology Surgical Oncology Transplant Surgery Trauma Surgery Urology VAMC Vascular Surgery Vet Science or, if not listed type in here:

Investigator's Name (first & last):                               Lab phone:  

Primary Lab Address:     City:     State:     Zip Code:

If you are working for more than one investigator, complete secondary address below:

Secondary Investigator's Name (first & last):           Lab phone:  

Secondary Lab Address:     City:     State:     Zip Code:

Sign me up for the Animal Scoop Listserv for Alerts and Notices:     Yes     No

The Animal Scoop ListServe is important because:
1) It allows a fast and sure way to alert all research staff using animals of any emergency situation
2) It provides updates regarding policy or service within University Animal Care.
3) It provides quick notification of things of vital concern to your research
4) It keeps labs informed by requiring that at least one member of each laboratory utilizing animals must subscribe to Animal Scoop.
5) ALL OF THE ABOVE - HINT: This is the correct answer.
To subscribe yourself to the Animal_Scoop listserv, send an email message to listserv@listserv.arizona.edu with the following information in the body of the email (no subject is required for the message). Subscribe Animal_Scoop <your name here> End

Check all classes you wish to complete:  Remember:  As of 12/31/01 protocols will not be approved unless all individuals listed have completed Laws & Regulations as well as Introduction to Animal Hazards Program.

When you hit submit you will receive a confirmation form ...please forward that confirmation to iacuctrn@ahsc.arizona.edu or print and fax to (520)621-3355 to complete the process.  Thanks!