Gorgas Vertebrate

Supervising Teacher or Scientist Additional Approval Forms
Alabama Science Scholar Search and Gorgas Scholarship Competition

VERTEBRATE ANIMAL APPROVAL FORM

REQUIRED FOR BEHAVIORAL NON-HUMAN VERTEBRATE ANIMAL PROJECTS OR VERTEBRATE ANIMAL OR HUMAN TISSUE STUDIES

This form must be submitted for any vertebrate animal project, including human tissue studies. It is to be completed and signed by the supervising scientist attesting to compliance with the non-human vertebrate animal project rule.  The rules for these projects are published in the Rules & Regulations booklet at https://student.societyforscience.org/international-rules-pre-college-science-research. Projects outside of these requirements are subject to disqualification.

This form should be scanned and emailed to gorgasscholarshipcompetition@gmail.com or ebbuckner@gmail.com with the subject of Gorgas-student last name – vertebrate.

Please indicate whether the student’s project included non-human behavioral research  or vertebrate animal tissue (including human)

Please complete either A or B and print and sign your name.

Behavioral Projects:

  1. List the genus, species and common name of animal(s) involved in the project.
  2. Where was the study conducted?
  3. Describe, in detail, the student’s interaction with the animals.

Vertebrate Animal or Human Tissue Projects:

  1.  List the genus, species, common name and tissue(s) or organ(s) of the animal(s) involved in the project.
  2. Please provide information regarding the vertebrate study from which the tissue was obtained. Include the name of the research institution, the title of the study, the Institutional Animal Care and Use Committee approval number and date of approval (where applicable). Human tissue studies where the tissue samples can be identified with a specific person must have IRB review and informed consent.
  3. Please read the following and sign below:

I verify that the student worked solely with non-living materials that were supplied to him/her by myself or qualified personnel from the laboratory; and that the animals used were sacrificed for a purpose other than the student’s research.