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 33% Contact information Application Type*New ApplicationRenewalName* First Last Date Date Format: MM slash DD slash YYYY Email* Phone 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 Registration Information Registration Category*IndividualDepartmentalRegistration Type*ResearchDispensing / Instructing*Chemical AnalysisImport / Export* Includes practitioner, pharmacy, and teaching activitiesSchedules Used*To select more than one Schedule, hold the "CTRL" key while making your selections...IIIIIIIVVTotal Quantity of Each Schedule* include units IIIIIIIVVHave you submitted your US DEAL/NC-DCU registration application / renewal yet?*YesNoI need assistance to completeNameThis field is for validation purposes and should be left unchanged.