Animal Activity Request

This form is to be used to request to bring animal(s) on campus for purposes other than teaching, research, testing, or personal/professional accommodation (students see the Dean of Students and employees see HR for information on accommodations). Note that this form should be completed 2-4 weeks prior to the first date the animal(s) would be on campus.

Name of Event:*
Event Date:*
MM slash DD slash YYYY
Event Duration*

Animal activity time frame
Select UW Oshkosh Campus*
Indicate the UWO campus where the animal activity will take place
Event Location:*

Include building and room number, if applicable
Campus Unit Sponsoring Event:*
Name of Campus Unit Contact*
First Last
Campus Contact Phone Number:
Campus Contact Email:*
Veterinarian Responsible for Animal Care:*

Please list the species, number, and ownership fo animal(s) to be brought to campus below:*

Species	Total Number	UWO OWNED (Include animal handler's name, contact information, & UWO Animal Certification Documents (Put N/A if not applicable))	PRIVATELY OWNED (Include Owner/Animal Handler's Name and Credentials, Contact Information, USDA dealer number (Put N/A if not applicable))

Provide a description of the event goal(s):*
Provide a description of what will be done to all animals listed on this form:*
Provide a description of how the animal(s) will be cared for in the event of an injury during the requested event:*
Provide a description of special precautions of safety measures that will be used to protect the public from hazards associated with the animals:*
(Examples: Post signage for persons with allergies, handler present at all times, etc.)
Are all the animals listed on this notification form up-to-date on vaccinations (if applicable to the species)?*
- Yes
- No
- N/A
Has the campus unit sponsoring the event provided appropriate notice to departments/entities who oversee the event location and received their approval?*
- Yes
- No
(Example: If the event is to be held in Polk Library, has the library director been notified of the event date, time and location?)
If bringing a therapy animal to campus, attach proof of current membership with an accredited organization (i.e., Therapy Dogs International (TDI)). Additional information may be requested after form submission.
Drop files here or

Max. file size: 5 MB.
By submitting this document to risk.safety@uwosh.edu, I agree to notify the Risk and Safety Office of any adverse/unexpected incidents within 24 hours of the event.*
I agree
Name of Individual Completing this Form:*
First Last
Date Form Completed*
MM slash DD slash YYYY