Animal Request Form

It is required that all fields be completed before submitting this form.
If you have questions, contact Liz Caskey, 332-5374.

Name
Phone Number
Email Address
Class
TA? Yes    No
Instructor or Advisor
Major Neuroscience   Biology      Psychology
Purpose
Senior Project  Independent Study      Other

If "other", please explain

Animal Information
Type
Quantity
Size
Sex Male      Female      Either
Date Wanted
Questions or Comments