Application form 4

Suitable types of evidence to support this application

 

Collection of blood sample

    • description of how often the applicant has completed this activity, over what time period, plus verification of competency by an experienced operator, e.g. local vet, officer of NSW Agriculture, qualified livestock research officer
    • description of any courses completed that provided training in this activity.

Artificial insemination

    • TAFE, university accreditation or equivalent by a registered training organisation (attach a scanned copy).

Semen collection

    • TAFE, university accreditation or equivalent by a registered training organisation (attach a scanned copy).

Sedation or tagging of fish

    • Description of how often the applicant has completed the activity, description of the method used
    • Description of any courses completed that provided training in this activity.

Nose ringing of cattle

    • description of how often the applicant has completed this activity, over what time period, plus verification of competency by an experienced operator, e.g. local vet, officer of NSW Agriculture, experienced contractor, experienced farmer
    • description of any courses completed that provided training in this activity.

Mulesing of young sheep

    • description of how often the applicant has completed this activity, over what time period, plus verification of competency by an experienced operator, e.g. local vet, officer of NSW Agriculture, experienced contractor, experienced farmer
    • description of any courses completed that provided training in this activity.

Slaughter and euthanasia of stock

    • description of how often the applicant has completed this activity, over what time period, plus verification of competency by an experienced operator, e.g. local vet, officer of NSW Agriculture, experienced farmer
    • description of any courses completed that provided training in this activity.

 

Application form 4
  • Application for certification to demonstrate a category 5 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
  • Name of teacher*
    5
  • School name*
    6
  • School address*
    7
  • School phone*
    8
  • School fax*
    9
  • Name of within-school Animal Welfare Liaison Officer*
    10
  • Please select any category 5 activity for which certification is sought and enter the species of the animal on which this activity is to be carried out.
    11
  • Activity*
    Collection of blood sample
    12
  • Species*
    13
  • Activity*
    Artificial insemination
    14
  • Species*
    15
  • Activity*
    Semen collection
    16
  • Species*
    17
  • Activity*
    Sedation or tagging of fish
    18
  • Activity*
    Mulesing of young sheep
    19
  • Activity*
    Nose ringing of cattle
    20
  • Activity*
    Slaughter or euthanasia of stock
    21
  • Species*
    22
  • Evidence of demonstrated competency must be provided for each activity for which the certification is applied. A list of suitable types of evidence is provided above this form. Click on the blue link to see the list. The applicant may provide other types of appropriate evidence.
    24
  • Attach supporting documents* Upload supporting files
      25
    • I declare that the information provided above is accurate and true and I understand that, if certification is granted, it will be for a period of three years.
      26
    • Please read the statement above and choose one of the following options:*
      I AGREE WITH THE STATEMENT
      I DISAGREE WITH THE STATEMENT
      27
    • Name of teacher*
      28
    • Teacher's Email*
      29
    • The School Principal has approved of the submission of this application*
      Yes
      No
      30
    • Name of Principal*
      31
    • Principal's Email*
      32
    • Date of application*
      33
    • Date of approval*SACEC Officer only to complete
      34
    • 35