Environment and
Sustainable Resource Development
Research Permit and Collection Licence Application
Cover Sheet
Date:
Project Title
Start Date
Completion Date
Principal Investigator
Phone No.
Fax No.
Email:
Include the following



Name All key participants in the project
Detailed project proposal including the locations where you will be conducting research or collections.
Additional Animal Care Committee Reviews (University, Institutional)
Applications are to be submitted either using email or the postal service.

Email submissions:
o One (1) copy of the completed application should be sent. To the following address:
SRD.WildResPermits@gov.ab.ca

Postal service submissions:
o One (1) copy of all written materials should be sent to:
Alberta Wildlife Research Permit and Collection Licence Applications
Environment and Sustainable Resource Development
7th Floor O.S. Longman Building
6909 – 116 St.
Edmonton, AB
T6H4P2
Tel: 780-422-9533 Fax: 780-422-9685
May 6, 2014
Research Permit and Collection Licence Application
Fish and Wildlife Policy Branch
© 2014 Government of Alberta
Page 1 of 5
Environment and
Sustainable Resource Development
Research Permit and Collection Licence Application
Date Received:
Application Number:
Project Title:
Start Date:
Completion Date:
Class Protocol followed for this Project:
Principal Investigator
Name:
Title/Position:
Organization/Department:
Region/Institution:
Address:
City:
Province:
Telephone:
Fax:
Postal Code:
Experience Relative to Current Proposal
Additional Investigators
Name:
Title/Position:
Organization/Department:
Region/Institution:
Address:
City:
Province:
Telephone:
Fax:
Postal Code:
Experience Relative to Current Proposal
Name:
Title/Position:
Organization/Department:
Region/Institution:
Address:
City:
Province:
Telephone:
Fax:
Postal Code:
Experience Relative to Current Proposal
May 6, 2014
Research Permit and Collection Licence Application
Fish and Wildlife Policy Branch
© 2014 Government of Alberta
Page 2 of 5
Research Permit and Collection Licence Application
1. Name Additional Key Participants:
2. Project Proposal (include details regarding background, goals, and objectives)
3. Details of Species and Number Required
4. CCAC Invasiveness Category (explain)
5. Details of Species and Number Required
6. Details of Anticipated Stress and Pain to Live Wildlife
7. Details of Capture, Handling and Disposition if Applicable (be specific)
May 6, 2014
Research Permit and Collection Licence Application
Fish and Wildlife Policy Branch
© 2014 Government of Alberta
Page 3 of 5
Research Permit and Collection Licence Application
Geographical Area
Select the ESRD Operations region within which the proposed research or wildlife collections will occur (check all
applicable areas)
ESRD Operations
Regions
Peace
Upper Peace
Lower Peace
Upper Athabasca
Lower Athabasca
North Saskatchewan/
Red Deer
South Saskatchewan
May 6, 2014
Research Permit and Collection Licence Application Cover Sheet
Fish and Wildlife Policy Branch
© 2014 Government of Alberta
Page 4 of 5
Research Permit and Collection Licence Application
Terms and Conditions:
This application is submitted and will be evaluated prior to the issue of a Research Permit or Collection Licence
by the Fish and Wildlife Policy Branch of Alberta Environment and Sustainable Resource Development. All
submitted applications become the property of Fish and Wildlife and will not be returned to the applicant. Projects
involving the capture and/or handling of live wildlife will be assessed by the Wildlife Animal Care Committee.
While every effort will be made to keep this information confidential, the application review procedures may
require that copies be distributed to a number of reviewers. The contents of this application form may be subject
to access under the Freedom of Information and Protection of Privacy Act.
Identify the specific study site(s) AND closest urban centre(s) (include legal land descriptions/GPS
reading, watershed, and any special access requirements if necessary):
Principal Researcher Signature
Date:
Additional Researcher Signature
Date:
Additional Researcher Signature
Date:
May 6, 2014
Research Permit and Collection Licence Application Cover Sheet
Fish and Wildlife Policy Branch
© 2014 Government of Alberta
Page 5 of 5