IACUC Amendment/Extension Approval Application

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Notes:

Please complete the application form with accurate information. Any application with inaccurate information and incomplete will result in the delay of your application processing.
Please take note of your amendmment/extension application ID and download link of your submitted form.
You will be informed via email for proposal deliberation.
For any inquiry kindly contact us via:

Email: iacuc@iium.edu.my or

Br. A'imullah: 09-5704733

Applicant Name *

Email *

example@example.com

Phone Number *

Area Code Phone Number

Principal Investigator Name *

Principal Investigator Email *

example@example.com

Initial IACUC Approval ID *

Project/Research Title *

Details of Amendment *

Title Animal Species/Strain/sexes Investigator Experimental Method Duration Statistical Method Sample Size/Animal Quantity

Please define the changes made. *

Please put all changes as selected above. (e.g. Title/Investigator/sample size/Experimental Method/Statistical Method)

Justification of the amendment made *

Does this amendment/extension applied prior expiry? *

Yes No

If no, kindly explain the reason here

Extension Start Date

Date

Extension End Date

Date

IACUC Amendment/Extension Approval Application

Initial Approval Information

Declaration & Signature