Application form 1

 

Application form 1
  • Application to allow students to use an animal for a class activity other than research (category 4 or 5 or non-listed activities).
    0
  • A separate application form is needed for each activity.
    1
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  • Have you attached a copy of your current completed Animal Research Authority? (This should be done at the end of the form prior to sign off).*select just one
    Yes
    No
    3
  • Does your school hold a current Animal Research Authority for category 4 or 5 activities?*select just one
    Yes
    No
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  • School name*
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  • School address*
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  • School phone*
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  • School fax*
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  • Name of within-school Animal Welfare Liaison Officer*
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  • Name of the teacher supervising the activity*
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  • Briefly describe the activity for which you are seeking approval. Please include a description of your method.*
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  • What is the activity category?*select just one
    category 4
    category 5
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  • Note: If you are seeking approval for a category 5 activity, please ensure that whoever is doing the actual teaching has a current SACEC certification to demonstrate the procedure.
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  • Who will be carrying out the activity?*select just one
    the teacher
    an instructor who is not a classroom teacher will be carrying out the activity while the teacher supervises
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  • Describe the preparation or training of students PRIOR to the actual activity for which approval is sought. Your answer could include examples of skill-building with equipment, using alternatives to simulate the task and risk assessment for animals and students.*
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  • What outcomes or competencies will students achieve by carrying out this activity?*
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  • Refer to Educational justification to answer the question below.
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  • Why do students need to use animals, rather than alternatives, to achieve these outcomes or competencies?*
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  • Where will the activity be carried out? (include address)*
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  • Describe what potential impact your activity will have on the animal’s wellbeing and how you will ameliorate the impact
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  • Impact*
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  • Amelioration*
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  • What responses have you planned in the event that complications arise from the activity that adversely affect the animal (e.g. illness, infection, injury)?*
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  • Please provide the following information about the animals to be used in this activity:
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  • Species*
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  • Age*
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  • Number of animals*
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  • Sex*
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  • Source*
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  • History of the animal’s prior exposure to humans*
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  • Have these animals been used for any other category 4 or 5 or non-approved activities?*
    Yes
    No
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  • Where will the animals to be used in this activity be housed?*
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  • Describe the type of housing to be provided*
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  • If animals are to be penned or caged describe the numbers and allocated space per animal*
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  • What will the animals be fed, and how often will they be fed?*
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  • Please provide the following information about the organisation of the activity:
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  • Maximum number of students to be supervised by the teacher at one time for the activity*
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  • Number of students carrying out the activity at the one time*
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  • Minimum and maximum number of animals to be used by each student*
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  • Maximum number of times each animal will be used by a student*
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  • Details of supervision by teacher*
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  • After-activity monitoring of animals*
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  • What will happen to the animals at the end of the activity?*
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  • Attach supporting documents* Upload supporting files
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    • By submitting this application I declare that the information provided above is accurate and describes the proposed activity. As the supervising teacher I accept responsibility for the care of the animals to be used and I declare that the activity will be carried out as detailed in the application form and in compliance with the Animal Research Act 1985 and the Australian Code of Practice for the Care and Use of Animals for Scientific Purposes.
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    • Please read the statement above and choose one of the following options:*
      I AGREE WITH THE STATEMENT
      I DISAGREE WITH THE STATEMENT
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    • Name of teacher*
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    • Teacher's Email*
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    • The School Principal has approved of the submission of this application*
      Yes
      No
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    • Name of Principal*
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    • Principal's Email*
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    • Date*
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