Module 1 - Applicant and general information (mandatory): application for a Migratory Birds Regulations, 2022 (MBR 2022) Scientific Permit

Alternate format

Protected A when completed.

Completion of this module is mandatory for a complete Scientific permit application. A complete Scientific permit application must include the completed modules relevant to all activities that are planned to be undertaken for the project/program.

Module 1: Applicant and general information (mandatory)

Applicant’s name:

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Section 1: General information

1.1.1 Type of request

[checkbox] New application

Have you previously held a MBR Scientific Permit in Canada (or a Bird Banding Permit in the United States)?

[checkbox] No [checkbox] Yes

If so, provide the permit number(s):

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[checkbox] Permit renewal

Current Scientific Permit number:

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Has an MBR report been submitted for this permit?

[checkbox] No [checkbox] Yes

[checkbox] Amendment to existing permit

Permit number:

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1.1.2 History

Have you ever had a MBR Scientific Permit suspended or cancelled?

[checkbox] No [checkbox] Yes

If yes, provide the reason:

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Have you ever been convicted of an offence under the Migratory Birds Convention Act or the Migratory Birds Regulations?

[checkbox] No [checkbox] Yes

If yes, please explain the conviction:

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Section 2: Applicant information

1.2.1 Applicant contact information

Given name (first name): [blank space]

Surname (last name): [blank space]

Position or title (for example: Director of Research, Bander in Charge): [blank space]

Prefixes or pronouns: [blank space]

Telephone (primary): [blank space]

Telephone (secondary): [blank space]

Email (primary): [blank space]

Email (secondary): [blank space]

1.2.2 Mailing address

Street: [blank space]

City: [blank space]

Province/Territory/State: [blank space]

Country: [blank space]

Postal Code: [blank space]

1.2.3 Organization information (if applicable)

Name: [blank space]

Website: [blank space]

Mandate or statement of purpose of organization: [blank space]

Type of organization (please select one option that best describes your organization):

[checkbox] Individual or condominium/strata corporation

[checkbox] Government

[checkbox] Agriculture

[checkbox] Telecommunications

[checkbox] Forestry

[checkbox] Mining

[checkbox] Oil

[checkbox] Electricity

[checkbox] Construction

[checkbox] Other Business or Commerce

[checkbox] Indigenous organization or government

[checkbox] Academic

[checkbox] Environmental Non-Government Organization

[checkbox] Hunting or Outfitter organization

[checkbox] Wildlife control organization

[checkbox] Tourism

[checkbox] Airport

[checkbox] Museum

[checkbox] Other (please specify): [blank space]

Note: If you are an environmental consultant, check the box that best describes the organization that engaged your services for this activity.

1.2.4 Organization’s mailing address (if different from above)

Street: [blank space]

City: [blank space]

Province/Territory/State: [blank space]

Country: [blank space]

Postal Code: [blank space]

1.2.5 Nominees (not applicable to banding applicants)

See Instructions to determine if you need to complete this section. Nominees cannot be added to Scientific Banding permits.

The applicant is responsible for ensuring that all nominees have the required experience and skills to undertake the activities listed below.

Name [blank space]

Organization [blank space]

Activities nominees will be conducting [blank space]

Nominee experience related to activities [blank space]

Section 3: Checklist of completed parts and attached documentation

[checkbox] Module 2: Activity and project/program information (mandatory)

[checkbox] One Module 2 per project/program

[checkbox] Resume or CV (or complete section)

[checkbox] Module 3: Capture and band birds

[checkbox] Animal Use Protocol (AUP) and Animal Care Committee (ACC) approval

[checkbox] Evidence of the applicant’s training (transcript, course certificates)

[checkbox] Report on applicant qualifications (RAQ)

[checkbox] Other documents describing procedures

[checkbox] Module 4: Capture, kill, injure and/or harass migratory birds, damage, destroy, remove and/or disturb nests and/or destroy, take and/or disturb eggs for scientific or educational purposes

[checkbox] Animal Use Protocol (AUP) and Animal Care Committee (ACC) approval

[checkbox] Other documents describing procedures

[checkbox] Module 5: Possess live birds (including rehabilitation)

[checkbox] A copy of the veterinarian’s current license

[checkbox] Facility photographs and floor plan (if a written description is not included)

[checkbox] Evidence of the applicant’s training (transcripts, course certificates)

[checkbox] International Wildlife Rehabilitation Council (IWRC) Certified Wildlife Rehabilitator membership

[checkbox] Module 6: Possess dead migratory birds, eggs, and nests

[checkbox] Module 7: Species at Risk

Section 4: Signature of applicant

I, (print name) attest that I have the ability and knowledge to accurately identify the species I am working with and safely conduct the activities for which I have applied. I certify that:

• I am 18 years of age or older
• All information submitted in this application is accurate and has been completed to the best of my knowledge
• I am aware of and will follow best practices in order to achieve high scientific, animal welfare and data standards
• I will not commence any prohibited activities that are the subject matter of this application before a valid permit is in my possession

I understand that, in order to legally conduct the activities, I may need to obtain additional permits or authorizations at the federal, provincial, territorial, municipal and/or other level.

A permit may be suspended or cancelled if the person to whom it was issued has failed to comply with any planned conditions set out in the permit.

Signature of applicant: [blank space]

Date: [blank space]

(sign with dark ink or digitally)

(yyyy-mm-dd)