Animal Use Training Registration Form

Instructions: 1. Use one form per registrant. 2. Submit completed form to the Animal Use Training Program via email (auts@uw.edu), campus mail (Box 357160), or fax (206-685-8648). 3. Please allow at least one week for processing; therefore, return form at least one week prior to the scheduled class. 4. "Walk-ins" will not be allowed to attend classes. Late registrations cannot be accepted. Please note: 1. University personnel and others working on UW IACUC protocols are not charged to attend classes. However, expenses are incurred even in the registrant's absence and a charge of $48.55 will be levied for persons who fail to attend a session if they have not cancelled 24 hours in advance. Non-University personnel are charged the current fee of $48.55 to attend. 2. Registration requests are acknowledged via email. Email reminders with complete information (e.g., meeting location) are sent a few days prior to classes. **PLEASE TYPE HANDWRITTEN FORMS WILL BE RETURNED**

Required Information for All Registrations

Name (last, first, m.i.): TaoBai Department: Chemical Engineering PI Name (last, first, m.i.): Jiang, Shaoyi IACUC Protocol #: 4203-01 Registrants Email Address: taobai@u.washington.edu For Non-UW Billing Contact: Billing Address: Personnel: Phone #: 206-495-2068 Box #: 351750 Dept. or PIs gift fund budget #: 61-7942
(Re-registrations only. Cant start with a 62-xxxx)

Required Information for Mouse/Rat Lab Requests

Date passed mouse/rat online exam: 12-19-2011 What techniques do you need to learn? Handling mice/rat, and perform techniques

Required Information for Facility Orientation Requests

Your proxy card # is printed on the back of the card. The PIN can be any 4 digits that you choose.

Gender: Male Female Facility you need access to: Proxy Card #:

Date passed SPF online exam (rodent users only): Housing room(s) you need access to: PIN: No, I do not need access between 6pm-6am

(e.g., 6th Floor, K-wing, T-wing, Foege, Brotman, or HR&T) Facility access is granted for 24x7; however, please let us know if you need after-hours access:

Yes, I need access between 6pm-6am If Yes, reason for after-hours access:

Class Requests
Provide at least two alternate class dates.

Class Foege Facility Orientation

Day 10 15

Date February February

Time 9:00-10:30 10:00-11:30

1st , 2nd, 3rd Choice 1st 2nd

Rev 11.4.10