RPI Controlled Substances Application

Principal Investigator

Department

Telephone Number

Date

Storage Location

Building/Room

Name of Controlled Substance and Drug Schedule

List each Controlled Substance and its drug schedule.

Will there be authorized users other than the PI?

Yes

Number of Authorized Users in Addition to the PI

Name of Additional Authorized User

Phone

Name of Second Additional Authorized User

Phone

Name of Third Additional Authorized User

Phone

Name of Fourth Additional Authorized User

Phone

Name of Fifth Additional Authorized User

Phone