<p> COMMITTEE FOR ETHICS IN ANIMAL EXPERIMENTATION APPLICATION FOR AUTHORISATION TO CONDUCT EXPERIMENTS USING ANIMALS (as required under the ACT Animal Welfare Act 1992)</p><p>Applicants name (incl. title):</p><p>Reason for authorisation: PhD: Hons: Other: (X) (X) (Explain)</p><p>Phone number: Email:</p><p>Institution: (University of Canberra or other)</p><p>Full address:</p><p>Name of research program(s) you will be associated with:</p><p>Formal qualifications including institution and date:</p><p>Animal Ethics test was Highest grade achieved: undertaken on:</p><p>EXPERIENCE Please describe your specific experience in animal handling and animal experimentation, with an indication of the periods/dates of that experience. If the applicant has no, or limited experience in animal handling and/or the techniques or procedures to be used to the next 3 years, please include details of any training that will be undertaken to develop the relevant skills and experience.</p><p>If you have a refereed publication(s) describing experiments that you have undertaken using animals, please cite reference(s).</p><p>If you do not have any applications then please state ‘none’.</p><p>Signature: Date:</p><p>Investigators authorised to conduct experiments using animals for research or teaching will receive an identity card which should be available for inspection on request by a member of the Ethics Committee or an authorised ACT inspector.</p><p>(Revised December 2008)</p>