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COSEWIC Annual Report - 2005

Appendix VIIII: COSEWIC Request for Species Assessment

Date of Application:_______________

Name(s) of applicant(s):


telephone, fax, email:

Status report: attached □   not attached□

Species(Scientific name, English and French common names):  


Species’ Distribution


            In Canada:

Imminence of Threat:

       extreme □      very high □             high□     moderate□   not known□   not applicable □

Is the threat of extinction or extirpation from Canada sufficiently grave as to warrant an emergency assessment?                                   yes □   no □

Justification for Request for Assessment (maximum 3 pages)

(i.e. evidence of decline, threats to the species, other reasons to suspect the species is at risk of extinction or extirpation from Canada)

Sources of Information:

The applicant(s) attest that the information in this request for assessment is, to the greatest extent possible, accurate and true. Furthermore, if a Species Status Report is attached, the author(s) agree(s) that the status report may be reviewed and edited by COSEWIC and the corresponding Subcommittee Co-Chair, that the author(s) will receive no royalty or other compensation from the Government of Canada or from COSEWIC, and that the manuscript contains no matter that is libellous, invades individual privacy, or infringes upon any proprietary rights.


Annex I

Declaration of Conflict of Interest

To accompany all applications

A separate copy of this form must be completed by each applicant.

Pursuant to the Request for Assessment of:


I, (name)________________________________, hereby declare any and all proprietary or commercial interest or conflicts of interest I may have that relate directly or indirectly to the subject of this application.




Annex II

Permission To Use Species Status Report

To accompany submission of a status report

I/We _________________________________ as legal owner(s) name(s) of the intellectual property in the Species Status Report entitled

(Update) Status report on the ____________________________________ in Canada

                                                          name of species

hereby grant permission to COSEWIC and to Environment Canada (EC) to use, edit, reformat, reproduce, modify, distribute, and share the Species Status Report, a copy of which is attached to this Permission, in whole or in part, in support of the COSEWIC species status assessment process.

I/we understand that EC will be using the Species Status Report to produce a COSEWIC Assessment and Status Report and future updates to this latter report.  I/we also understand and agree the COSEWIC Assessment and Status Report and future updates shall be the intellectual property of EC and that I/we have no rights to them.

I am/we are submitting, with this Permission, waivers of Moral Rights from all authors who contributed to the Species Status Report.












Annex III

Waiver of Moral Rights

To accompany submission of a status report

A separate copy of this form must be completed by each author.

I ________________________________ declare that I

name of author

have contributed to the creation or production of the Species Status Report entitled:

(Update) Status report on the ______________________________________ in Canada

                                                                               name of species

(hereinafter referred to as the "Work") and briefly described as a report containing the best available information on the species status in Canada that will form the basis for a status assessment by the Committee on the Status of Endangered Wildlife in Canada (COSEWIC). I recognize that:

 name(s) of copy right owner(s):

is/are the lawful owner(s) of the copyright in the Work.

I am are fully aware that my moral rights, as defined by the Copyright Act, include a) the right of having my name associated with the Work, where reasonable in the circumstances; and b) the right to the integrity of the Work such as preventing the Work from being changed, corrected or amended.

I hereby waive in whole all moral rights which I may have in the Work in favour of the Government of Canada (Environment Canada), including the right to the integrity of the Work, the right to be associated with the Work in all contexts and in connection with all products and/or services.

For purposes of this Waiver, "Work" shall include without limitation all multimedia presentations, software, documentation, data, designs, reports, flowcharts, specification and source code listings, and of any related works, including any enhancements, modifications, or additions to the software and hardware products owned, marketed, or used by the Government of Canada.

Signed, sealed and delivered in the presence of

______________________                             ______________________

Witness (signature)                                Author (signature)

______________________                             ______________________

Name of Witness (printed)                          Name of Author (printed)



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