Notification of Controlled Substances Registration – Environmental Health and Safety

Please complete and submit this form to EH&S when registering or renewing your NC state and DEA controlled substances registration. This form is for EH&S notification only and is not part of the registration process with the state and federal administrations.

Step 1 of 3

Contact information
Application Type*
- New Application
- Renewal
Name*
First Last
Date
MM slash DD slash YYYY
Email*
Phone

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Location Information
PI Name*
First Last
Department*
Building*
Room(s) Controlled substances storage area*
Enter one room number per space, select the "+" button to add additional rooms
Room(s) Controlled substances use area*
Enter one room number per space. Enter one room number per space, select the "+" button to add additional rooms

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Registration Information
Registration Category*
- Individual
- Departmental
Registration Type*
- Research
- Dispensing / Instructing*
- Chemical Analysis
- Import / Export
* Includes practitioner, pharmacy, and teaching activities
Schedules Used*
To select more than one Schedule, hold the "CTRL" key while making your selections...
Total Quantity of Each Schedule*
include units
I II III IV V
Have you submitted your US DEAL/NC-DCU registration application / renewal yet?*
- Yes
- No
- I need assistance to complete
Name
This field is for validation purposes and should be left unchanged.

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