I, _______________________ certify that the experiments outlined in my proposal entitled, _________________________________________________________________ are exempt from review by and registration with the Institutional Biosafety Committee (IBC) because: (Check all that apply.)

• the experiments are not in organisms or viruses.
  
• the experiments consist entirely of DNA segments from a single nonchromosomal or viral DNA source.
  
• the experiments consist entirely of DNA from a prokaryotic host including its indigenous plasmids or viruses when propagated only in that host (or a closely related strain of the same species), or when transferred to another host by well established physiological means.
  
• the experiments consist entirely of DNA from an eukaryotic host including its chloroplasts, mitochondria, or plasmids (but, excluding viruses) when propagated only in that host (or closely related strain of the same species).
  
• the experiments consist entirely of DNA segments from different species that exchange DNA by known physiological processes, though one or more of the segments may be a synthetic equivalent. (See Appendix A of NIH Guidelines for lists of such exchangers.)
  
• the experiments do not present a significant risk to health or the environment. (See Appendix C of NIH Guidelines for exempt classes of experiments.)
  
  

Principal Investigator: Typed or Printed Name

_________________________________________ _____________________________ Signature Date

Department Chair: Typed or Printed Name

________________________________________ _____________________________ Signature Date

CSU-OSPR 4/1/95