Research Request Form - Southwest National Primate Research Center

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A. Personal Data

Name*

Texas Biomedical Research Institute

Auto fills Texas Biomedical Research Institute's address data.

Institution*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

B. Project Information

Title of Study:*

Will the animals be used for AIDS-related research?*

Yes
No

C. Funding

Will the resource be used for NIH-funded research?*

Yes. Existing Federal Grant and have Grant number
Yes. New Federal Grant Application and have a field for RFA and submission date
Non-federal funding

Please indicate the RFA and submission date.*

If non-federal funding please specify, and include submission date.*

Grant Number*

Submission Date*

Data Sharing Plan*

If this federally funded project will generate data that may be shared with qualified investigators, please include a brief paragraph description of the final data that will be shared. Data useful to other investigators may include routine clinical data generated for project animals in addition to research results. (1000 characters or less)

Funding Source*

D. Animal information

Species*

Baboon (Papio), any subspecies
Marmoset
Indian-origin rhesus (Macaca mulatta)
Other

Number of Animals Needed*

Sex*

Age*

Units (Age)*

Duration of Study (live animal work)*

Units (Duration of Study)*

Planned Start Date of Animal Work*

E. Housing Information

What level of biological safety will housing for this project require?*

Standard Housing
BL2
BL3
BL4

F. Other Project Considerations

Other Project Considerations

Diet restriction
Single housing
Paired housing
Behavioral training
Nursery rearing

G. Overview of the Procedures and Timeline for the Project

Provide an overview of the procedures and timeline for the project*

Upload docs/PDF here if needed.

Max. file size: 50 MB.

H. If you have discussed this request with an SNPRC staff member, please provide a name.

SNPRC Staff Member Name: