Personal Details First Name - in Hebrew * Surname - in Hebrew * First Name - in English * Surname - in English * Israeli ID / Passport # * E-mail * Cell Phone * Academic Degree Faculty where you currently work * Department where you currently work * Campus * Ein Kerem Safra Mount Scopus Hadassa Other Other * Affiliation to the institution * Principal Investigator Investigator A Physician Laboratory technician/ Assistant Student Post Doc. Intern Ethics Committee Member Veterinarian Other Other Affiliation * Please attach one of the following:1. Document indicating that you belong to the Hebrew University Academic Faculty.2. A Letter from Hadassah Deputy Director R&D Division (lhadas@hadassah.org.il) indicating that you are a PI. More informationFiles must be less than 2 MB. Allowed file types: gif jpg jpeg png rtf html pdf doc docx. Upload PI documantation * Student's work status in the lab * BA Student performing research in the lab MA Student performing research in the lab Ph.D. Student performing research in the lab Student working on an hourly rate Visiting student for a short time from another country/institute/academy Other student definition – please specify Other Student status in lab * Laboratory (PI=The Principal Investigator, The Professor) affiliation * Please indicate the name and ethical code number of the Principal Investigator (The Head of the lab, The Professor) you are working with in the lab Have you received a temporary Ethics authorization/number in the Hebrew University in the past? * Yes No Please indicate the temporary number, the animal species, and the date (year) of validation Temporary code * Activity in animal treatment or animal trials Animal types you expected to work with * Rodents Other Please specify Mice or Rats rodents type * Please specify other type * My official training in ethics of animal care and/or animal trials is: * I do not have former training / practice I have previously participated in course/s of Ethical use of laboratory animals at the Hebrew University \ other institutes. Please specify the courses (Full names/course titles) and the year\s of participation. I have a practical experience in conducting experiments with animals (Please list animal species, types of treatments, trials and procedures you have performed, the scope of the experience) * Please write where (indicating name of Institute, department, and name of PI or lab) and when (years) you have practiced. Training details * Please attach the official personal certificate/s or the formal letter of authorization that you have received (for courses taken in institutes other than HUJI), and the course Syllabus or, alternatively, list of subjects/ topics. More informationFiles must be less than 2 MB. Allowed file types: gif jpg jpeg png rtf html pdf doc docx. Upload Course details * Applicants Declaration 1) I have read the following documents: a) Prevention of Cruelty to Animals Law (EXPERIMENTS ON ANIMALS) 1994 b) Prevention of Cruelty to Animals Rules (EXPERIMENTS ON ANIMALS) 2001 c) The Hebrew University regulations regarding the use of Laboratory Animals.2) I have understood their intention, and the resulting limitations and duties, and I am obligated to act by them and by any Hebrew University regulation. Full name of applicant * Date * Day12345678910111213141516171819202122232425262728293031 Day MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Year20222023202420252026 Year PI's full name * PI's Personal Ethics number * PI's Email * Submit
