This form certifies that a project involving the use of vertebrate animals, Cephalopods, animal embryos, or animal tissues, is in compliance with Policy 4.2.2 Use of Vertebrate Animals and Cephalopods in Research.

Region
Project Title
First Name / Last Name / Email / Phone
Student 1
Student 2
Chair, RSF1
Chief Judge, RSF
Adult Supervisor
Scientific Supervisor
Chair Ethics Committee
This project involves: / Vertebrate Animals / Cephalopods / Animal Tissue

Request for Ethics Approval

I have visited and understood the web site of the YSC National Ethics and Safety Committee

I have read and understood Policy 4.2.2Use of Vertebrate Animals and Cephalopods in Research

Signed - Student 1 DateSigned - Student 2Date

Signed – Adult SupervisorDateAdult Supervisor Affiliation

Signed – Scientific SupervisorDateScientific Supervisor Affiliation

Ethics Approval

I certify that this project involving the use of animals is in full compliance with Policy 4.2.2Use of Vertebrate Animals and Cephalopods in Research, and that it is eligible for the Regional Science Fair and the Canada Wide Science Fair.

Signed – Chair, RSF Ethics CommitteeDate

1Or designate.

Form 4.1C: Animals – Instructions

  1. Form 4.1C

This form certifies that a project involving the use of vertebrate animals, Cephalopods, embryos or animal tissue is in full compliance with Policy 4.2.2 Use of Vertebrate Animals and Cephalopods in Research.

  1. Documents

The Research Proposal must be available to the Adult Supervisor, along with form 4.1C.

  1. Instructions for Participants in the Regional Science Fair
  2. Fill in Form 4.1C on a computer, not by hand.
  3. Print the completed Form 4.1C, and then get it signed with all the required signatures.
  4. Make a paper copy of this completed and signed form.
  5. Store the original signed copy of form 4.1C in a safe place.
  6. Take the copy of signed form 4.1C to your Regional Science Fair.
  1. Instructions for Finalists selected for the Canada Wide Science Fair
  2. Scan the original signed copy of form 4.1C. Convert it to pdf format. To learn how to convert your scanned image to a pdf file, type phrases such as “Scan to pdf file’ into your favourite search engine.
  3. Upload the completed and signed, electronic copy of form 4.1C on your computer to theForms area of the CWSF registration site.

4 August 2012Youth Science Canada Form 4.1 CVertebrate Animals and Cephalopods Approval