Application form 2

 

Application form 2
  • Application for students to use an animal for a research project which involves a category 4 or 5 activity or a non-listed activity.
    0
  • A separate application form is needed for each activity.
    1
  • 2
  • 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
    4
  • 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 project*
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  • Title of the research project*
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  • Aim of the research project*
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  • Method of conducting the research project*
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  • What is the activity category of the project?*select just one
    category 4
    category 5
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  • What other similar studies have previously been carried out? How does this one differ and what reasons are there for this one being repeated (if it is the same)?*
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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 project?*
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  • What qualifications/skills/experiences does the supervising teacher have related to supervision of this project?*
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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 competancies?*
    20
  • Have these animals been used for any other category 4 or 5 or non-approved activities?**
    Yes
    No
    21
  • Where will the project be carried out? (include address)*
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  • What strategies do the students have in place to monitor the wellbeing of the animals during the project?*
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  • What strategies does the teacher have in place to monitor the project?*
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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 project 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 project:
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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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  • What will happen to the animals at the end of the project?*
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  • History of the animal’s prior exposure to humans*
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  • Justify the species and numbers of animals chosen to be used in your project*
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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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  • Proposed date of completion*
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  • Proposed date of commencement*
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  • What preparatory work has been done to address the following issues?
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  • What criteria have been used to select the animals for the project, e.g. genetic make-up, age?*
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  • How can the minimum nutrition required for the selected type of animal, taking into account its age, sex and stage of production, be satisfied?*
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  • What known diseases and pests may be encountered in the selected type of animal during the project? Explain how these will be controlled.*
    53
  • What known diseases and pests may be encountered in the selected type of animal during the project? Explain how these will be controlled.*
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  • Describe the types of caging or pen that will be used for the animals (including details of the density)*
    55
  • How can the effects of noise be limited to acceptable levels for the selected animals?*
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  • Describe how the appropriate photoperiod, temperature, humidity and ventilation will be provided at all times?*
    57
  • Is the project designed so that statistically valid results can be obtained using the minimum number of animals necessary?*
    58
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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 student*
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    • Student's Email*
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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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