40 Years UTPB - The University of Texas of the Permian Basin

Scientific Review Committee (SRC) & Institutional Review Board (IRB)

Registration, 2012 Form

School/Local Fair:_______________________________________________________________
Director:_______________________________________________________________________
Director Phone:_________________________________________________________________

1) Chairperson:____________________________ Field of Study:_________________________
Degree(s) and/or Qualification:_____________________________________________________
Institutional Affiliation:_____________________________________________________________
Mailing Address: (Street)__________________________________________________________
(City,State,Zip)__________________________________________________________________
Phone Number:_________________________________________________________________
Email Address:_________________________________________________________________

2) Member:_____________________________________ Field of Study:___________________
Degree(s) and/or Qualification:____________________________________________________
Institutional Affiliation:____________________________________________________________
Mailing Address: (Street)_________________________________________________________
(City,State,Zip)_________________________________________________________________
Phone Number:________________________________________________________________
Email Address:_________________________________________________________________

3) Member:__________________________________ Field of Study:______________________
Degree(s) and/or Qualification:____________________________________________________
Institutional Affiliation:____________________________________________________________
Mailing Address: (Street)_________________________________________________________
(City,State,Zip)_________________________________________________________________
Phone Number:________________________________________________________________
Email Address:_________________________________________________________________

The SRC must have at least three members. One member must be a biomedical scientist (Ph.D., M.D., D.V.M., D.D.S., D.O.), one a science teach, and at least one must be familiar with animal care procedures. If the SRC serves also as the IRB, one member must be a psychologist or a psychiatrist. Please return to the PBRSF, MB 3265, 4901 E. University, Odessa, TX by November 30.