IACUC Services Form CTAC IACUC Services This form captures client information submitted for the purpose of performing IACUC service functions. This form is designed to enable the user / client to indicate the service of interest, identify the PI, fiscal contact and appropriate funds and authorize the initiation of services. First, let's get a little information on you as the client and the PI you work for.Name* First Last Email* Phone*Bill to (PI name)* First Last Address* Department Building Room # OK, now lets see what service you are interested in today.I am interested in:* New Animal Use Protocol Service Triennial Renewal of AUP Service Addendum to AUP Service AUP Search Data Service myIACUC Training Service Now we will gather the information for identifying the account or fund that you will use for payment of the service to be rendered. This will include the contact information for your departmental fiscal person, and the ChartField string identifying the account.Name (Fiscal Contact)* First Last Phone*FAX*Email* Chartfield Info: Department I.D.*Please enter a number less than or equal to 8.Chartfield Info: Fund*Please enter a number less than or equal to 3.Chartfield Info: Program*Please enter a number less than or equal to 4.Chartfield Info: Account*Please enter a number less than or equal to 6.Chartfield Info: Budget Reference*Chartfield Info: Source*Chartfield Info: FlexChartfield Info: Project*Please enter a number less than or equal to 8.PI Grant Reference*Descriptive name for the PI to identify the funding source. (ie: NIH RO1, Start-up, Am Heart Assn., etc.)This last section is to provide signature authority from the Principal Investigator to authorize fund deduction for services rendered.Authorizing PI Signature*Date*
