Education and Management Application: Wildlife/Listed Fish/Protected Flora

Use this application form to apply for permits for education and management purposes under the Wildlife Act 1975 and Flora and Fauna Guarantee Act 1988.

If you wish to apply for a permit for research purposes, please visit the research permit application form.

Applicant Details

Title (required) *

First Name (required) *

Other Given Name

Family Name (required) *

Date of Birth (required) *

Organisation

Email Address (required) *

Phone Number (required) *

Address (required) *

Street address

City

State

Postcode

Activity details

What are you applying to take and/or keep? Select all that apply (required) *

Wildlife (including terrestrial invertebrates listed under the Flora and Fauna Guarantee Act 1988)Protected Flora (Flora listed as Protected or Threatened under the Flora and Fauna Guarantee Act 1988)Fish, freshwater crayfish, and aquatic invertebrates (listed under the Flora and Fauna Guarantee Act 1988)

For what purpose do you wish to take and/or keep wildlife? (required) *

EducationConservation (e.g. captive breeding of threatened species)Management (e.g. consultants planning to relocate wildlife and/or general fauna surveys)Aboriginal cultural purposesOther

If 'Other', please specify. (required) *

For what purpose do you wish to take and/or keep protected flora? (required) *

If 'Other', please specify. (required) *

For what purpose do you wish to take and/or keep FFG-listed fish, freshwater crayfish and aquatic invertebrates? (required) *

EducationConservation (e.g. captive breeding)Management (e.g. consultants proposing to relocate fish, freshwater crayfish and aquatic invertebrate, and/or general surveys)Aboriginal cultural purposesOther

If 'Other', please specify. (required) *

Description of Activity

Please describe your proposed activities (required) *

Proposed Start Date (required) *

Proposed Finish Date (required) *

Is this a renewal of an existing permit? (required) *

YesNo

Please provide details of the previous permit below

Permit Number *

Expiry date *

Wildlife Species

If you intend to take wildlife from any land managed by Parks Victoria, you will also need to apply through ParkConnect for an Access Agreement. If you have permission from the landholder, no permit is required to take Protected Flora from private land for non-commercial purposes.

Begin typing in the box below to search for the appropriate species.

Wildlife Species (required) *

Quantity (required) *

Add another species? (required) *

YesNo

Wildlife Species (required) *

Quantity (required) *

Add another species? (required) *

YesNo

Wildlife Species (required) *

Quantity (required) *

Add another species? (required) *

YesNo

Wildlife Species (required) *

Quantity (required) *

Add another species? (required) *

YesNo

Wildlife Species (required) *

Quantity (required) *

Please list below any additional or other wildlife species and quantity, or you may upload a document below

If you selected 'various' species, please provide any additional information below

Wildlife Upload

Browse

Wildlife Activities

Please select all relevant boxes.

If you selected 'Other capture/trapping method', please specify. (required) *

Wildlife uses: (required) *

If you selected 'Captive breeding', please provide information about how animals surplus to requirements will be disposed of (required) *

If you chose 'Other activities' please specify (required) *

Do you intend to keep wildlife? (required) *

YesNo

Please provide the address where it will be kept.

Street Address (required) *

City/Suburb/Town (required) *

Postcode (required) *

Protected Flora Species

If you intend to take flora from any land managed by Parks Victoria, you will also need to apply through ParkConnect for an Access Agreement. If you have permission from the landholder, no permit is required to take Protected Flora from private land for non-commercial purposes.

For further information please view the Threatened Flora, Non-Threatened Protected Flora, and Threatened Communities list.

Do you intend to take and/or keep any threatened flora species? (required) *

YesNo

Begin typing in the box below to search for the appropriate species.

Where species are unknown, please select "various" from the drop-down box below.

Please select threatened flora species (required) *

Plant Part (required) *

Quantity (required) *

Add another species? (required) *

YesNo

Please select threatened flora species (required) *

Plant part (required) *

Quantity (required) *

Add another species? (required) *

YesNo

Please select threatened flora species (required) *

Plant part (required) *

Quantity (required) *

Add another species? (required) *

YesNo

Please select threatened flora species (required) *

Plant part (required) *

Quantity (required) *

Add another species? (required) *

YesNo

Please select threatened flora species (required) *

Plant part (required) *

Quantity (required) *

Please list below any additional or other threatened flora species, plant part, and quantity (required)

If you selected 'various' threatened flora species, please provide any additional information below

Do you intend to take and/or keep any non-threatened protected flora species? (required) *

YesNo

Please enter species scientific name, plant parts (e.g. Whole plant, Seed, Herbarium specimen), and quantity (required) *

Do you intend to take and/or keep any flora from threatened communities? (required) *

YesNo

Please select threatened communities (required) *

Proposed area (sqm) (required) *

Listed fish, freshwater crayfish, and aquatic invertebrate species

If you intend to take listed fish/crayfish or aquatic invertebrates from any land managed by Parks Victoria you will also need to apply through ParkConnect for an Access Agreement.

In addition to the permit under the Flora and Fauna Guarantee Act 1988, approval may be required under the  Fisheries Act 1995. Please contact the Victorian Fisheries Authority .

Begin typing in the box below to search for the appropriate species.

Please list species (required) *

Quantity (required) *

Add another species? (required) *

YesNo

Please list species (required) *

Quantity (required) *

Add another species? (required) *

YesNo

Please list species (required) *

Quantity (required) *

Add another species? (required) *

YesNo

Please list species (required) *

Quantity (required) *

Add another species? (required) *

YesNo

Please list species (required) *

Quantity (required) *

Add another species? (required) *

YesNo

Please list any additional species and quantity

Use of listed fish, freshwater crayfish, aquatic invertebrates

Please select all relevant boxes.

If you selected 'Other capture/trapping method', please specify. (required) *

If you selected 'Keeping/breeding in captivity', please provide information about how animals surplus to requirements will be disposed of (required) *

If you selected 'Other methods', please specify (required) *

Do you intend to keep fish, freshwater crayfish and/or aquatic invertebrates? (required) *

YesNo

Please provide the address where fish, freshwater crayfish and/or aquatic invertebrates will be kept.

Street Address (required) *

City/Town/Suburb (required) *

Postcode (required) *

Proposed sites

If proposing to take from the wild and/or humane euthanasia, you must include details on the location where wildlife will be taken from.

If proposing to keep wildlife in captivity, you must include a complete street address of where the animals will be held.

For translocation and/or take from the wild, you must include details on the location where species will be kept, collected from and/or released. Please also include the street address of any location where species will be kept for the duration of the project.

Please include the street address of any location where flora specimens will be kept for the duration of the project.

Please include the street address of any location where fish will be kept for the duration of the project.

Please note, a permit does not convey the right of entry to any property or site (including public or Crown Land) to conduct authorised research activities. Prior permission from the landowner or manager is required.

Proposed location(s) (required) *

Ethics Approval

Ethics approval may be required for activities that include; collection of biometric data, tagging and attaching tracking devices, blood / tissue sampling, trapping, attaching telemetry devices, take from the wild and humane euthanasia. For further information visit A n imal Welfare Victoria.

If you have obtained ethics approval please provide details below. A copy of the ethics application and approval must be submitted with the application.

Animal Ethics Approval Reference Number

Approval Date

Expiry Date

Please upload your ethics approval

Browse

Please upload your approved ethics application.

Browse

Acknowledgment by Applicant

I,

being the applicant for this Wildlife Act Research Permit, acknowledge that it is an offence under Section 58B of the Wildlife Act 1975 to provide false or misleading information in, or in connection with, the application for a Wildlife Act permit and I state that the information that I have provided is true, correct and complete.

being the applicant fo r this Flora and Fauna Guarantee Act Permit, ackn owledge that the information that I have provided is true, correct and complete.

If any of the names shown above are not correct, please re-enter your personal details at the top of this form before submitting the application.

Signature (required) *

Draw signature|Type signatureClear

Date (required) *

Collection, use and disclosure of personal information - Privacy and Data Protection Act 2014

The Department of Environment, Land, Water and Planning (DELWP) is committed to protecting personal information provided by you in accordance with the principles set out in the Victorian privacy laws. This privacy statement applies to the collection and use of personal information, voluntarily provided by you, in relation to administration of licences and authorisations administered under the Wildlife Act 1975.

The information you provide will be used to assess your application, administer any relevant licences or authorisations and carry out compliance relating to those licences or authorisations.

DELWP or its contracted service providers under confidentiality agreements may survey you about your experience with DELWP.

You may apply for access to your personal information at any time to confirm that it is accurate and up to date, upon payment of a prescribed fee (if any). Enquires should be directed to the DELWP Customer Service Centre on 136 186.

The Department of Environment, Land, Water and Planning (DELWP) is committed to protecting personal information provided by you in accordance with the principles set out in the Victorian privacy laws. This privacy statement applies to the collection and use of personal information, voluntarily provided by you, in relation to administration of licences and authorisations administered under the Flora and Fauna Guarantee Act 1988.

The information you provide will be used to assess your application, administer any relevant licences or authorisations and carry out compliance relating to those licences or authorisations.

DELWP or its contracted service providers under confidentiality agreements may survey you about your experience with DELWP.

You may apply for access to your personal information at any time to confirm that it is accurate and up to date, upon payment of a prescribed fee (if any). Enquires should be directed to the DELWP Customer Service Centre on 136 186.