BIOBEHAVIORAL RESEARCH DIVISION - Cedars-Sinai · Project and Behavioral Tests . Please provide title and brief description of project ... Please provide the list of vivarium rooms

CEDARS-SINAI BIOBEHAVIORAL RESEARCH DIVISION 310-423-8182 ● [email protected] Page 1 of 3

Requestor Information

Name Last First M.I.

Department Room

Phone Email

Principal Investigator Project ID Billing Account

Project and Behavioral Tests

Please provide title and brief description of project

IACUC Protocol IACUC ExpirationRequired mm/yyyy

Behavioral Tests Dates Requested 1) 2) 3)

Approximate Dates

Please list the names of ALL users■ who will need access to the Biobehavioral Research Division facility 1) 2) 3) 4) 5)

■For access to the Biobehavioral Research Division facility, ALL users must read and sign the Guidelines for EquipmentUse and the Facility Decontamination Protocol forms. Please return the forms to the Biobehavioral Research Division staff.

BIOBEHAVIORAL RESEARCH DIVISION

BIOBEHAVIORAL RESEARCH DIVISION SERVICE REQUEST


CEDARS-SINAI BIOBEHAVIORAL RESEARCH DIVISION 310-423-8182 ● [email protected] Page 2 of 3

Animal Information

Equipment used in this facility must be sanitized between experiments. However, the removal of airborne materials, as well as particles and debris from porous surfaces and equipment, cannot be ensured. Therefore, we require full disclosure of pertinent health and treatment information on experimental animals to avoid potential cross-contamination to subsequent equipment users.

Describe any precautionary measures that are required for handling and/or housing these animals including bedding disposal

(Special handling fees may apply)

Please provide the list of vivarium rooms where animals are housed

Species/Strain Treatments or Groups Sex (M/F) Age Total (n)

IMPORTANT: ANIMALS REQUIRING SPECIAL HANDLING OR HOUSED IN RESTRICTED ACCESS ROOMS WITHIN THE VIVARIUM ARE NOT TO ENTER THE BIOBEHAVIORAL RESEARCH DIVISION FACILITY WITHOUT PRIOR NOTIFICATION AND APPROVAL BY COMPARATIVE MEDICINE.


CEDARS-SINAI BIOBEHAVIORAL RESEARCH DIVISION

Behavioral Testing Options

● Facility Fee* = $50/hr ● Assistance Fee** = $75/hr ● Technician Fee*** = $100/hr ●● Professional Fee■ = $100/hr ●

(Check all that apply) Behavioral Test 1

1. * Equipment Use Only – Testing Carried Out by Investigator’s Laboratory Staff (ALL listed users MUST complete adequate training provided by the Biobehavioral Research Division staff prior to request Option 1)

2. ** Supervision/Training and/or Data Compilation Provided by Biobehavioral Research Division Staff3. *** Testing Conducted and Data Compiled by Biobehavioral Research Division Staff4. ■ Data Analysis (compilation, organization and statistics)5. ■ Experimental Design, IACUC Protocol, Report Preparation (progress report and grant proposal)

Behavioral Test 2 1. * Equipment Use Only – Testing Carried Out by Investigator’s Laboratory Staff

(ALL listed users MUST complete adequate training provided by the Biobehavioral Research Division staff prior to request Option 1)


Behavioral Test 3 1. * Equipment Use Only – Testing Carried Out by Investigator’s Laboratory Staff

(ALL listed users MUST complete adequate training provided by the Biobehavioral Research Division staff prior to request Option 1)


For Biobehavioral Research Division Use Only

Date or Period of Time Description Units Rate Fee

TOTAL

Month of Service Project ID PI

Additional Notes:

310-423-8182 ● [email protected] Page 3 of 3

mm/yyyy

Documents

BIOBEHAVIORAL RESEARCH DIVISION - Cedars-Sinai · Project and Behavioral Tests . Please provide title and brief description of project ... Please provide the list of vivarium rooms