1. Principal Investigator (PI): Last Name: *First name: *2. DepartmentDepartment Chair:3. Office (Building / Room #):Lab Location (Building/Rm): *4. Phone Number: *E-mail:5. Project Title: *6. Committee Protocol Number(s): IACUC *IBCIRB7. Grant Funding Agency:8. Budget #:UMES Grant/Contract Account #:9. Protocol Approval Date: *10. List all other faculty/staff/graduate/undergraduate personnel (including principal investigators) working on this project. Check the box for "Safety Training" for those who have completed safety training. NameRankSelectFacultyStaffGraduate StudentUndergraduate StudentSelectSafety TrainingSafety TrainingTraining Date(s)NameRankSelectFacultyStaffGraduate StudentUndergraduate StudentSelectSafety TrainingSafety TrainingTraining Date(s)NameRankSelectFacultyStaffGraduate StudentUndergraduate StudentSelectSafety TrainingSafety TrainingTraining Date(s)NameRankSelectFacultyStaffGraduate StudentUndergraduate StudentSelectSafety TrainingSafety TrainingTraining Date(s)NameRankSelectFacultyStaffGraduate StudentUndergraduate StudentSelectSafety TrainingSafety TrainingTraining Date(s)NameRankSelectFacultyStaffGraduate StudentUndergraduate StudentSelectSafety TrainingSafety TrainingTraining Date(s)NameRankSelectFacultyStaffGraduate StudentUndergraduate StudentSelectSafety TrainingSafety TrainingTraining Date(s)11. The research project involves the following:AnimalsBiological MaterialChemicalsControlled SubstancesEducational ResearchHuman SubjectsRadioactive materialRadiation-producing equipmentNon-Ionizing RadiationBiological Material Including:PathogensrDNABloodSerumUnfixed tissuehuman cell cultureOther: Please specify:12. Please list licenses and/or permits (e.g. import/export of selected agents, rare and endangered species) associated with this project.13. Please provide a protocol-specific description of how hazardous procedures will be controlled to protect personnel (e.g. personal protective equipment, work practices, etc.)14. Please describe post-exposure procedures that will be followed in the event of an accidental exposure.15. Please provide a project description from the grant or contract (copy and paste).16. Please provide a description of the project in layman's terms (do not cut and paste from grant application). Limit 100 words. Submit Form To Office of Sponsored Research & Programs
