Research and Monitoring Permit Application

Note: In the interest of standardization and simplicity, these are the same questions, with minor modification, asked by the US Fish and Wildlife Service for projects on National Wildlife Refuges; OMB Control # 1018-0102.

Type of Permit:

Principal Investigator

First Name:

Last Name:

Attach Curriculum Vitae or Resume:

Is Curriculum Vitae or Resume Attached?

Affiliation/Sponsoring Organization:

Relationship to Affiliation/Sponsoring Organization: (professor, staff, student, etc.)

Street Address:

City:

State:

Zip Code:

Office Phone:

Cell Phone:

E-mail:

List of Known Assistants/Sub-Permittees:

Project Title:

Attach Full Research Proposal:

Is Full Research Proposal Attached?

Describe project by specifically identifying timing, frequency, and how the project is expected to proceed:

Provide GPS location(s) of project:

Is map of location(s) required?

Identify species or habitat being studied:

Purpose/hypothesis:

Expected benefits of research/monitoring:

Briefly describe project history and context of research/monitoring project:

Briefly describe project’s relationship to other research/monitoring projects either known of or conducted by the applicant:

Identify the types of samples to be taken or data to be collected during proposed project:

List other cooperators and institutions involved in the project:

Generally identify the anticipated timeline for analysis, write-up and publication:

For research involving vertebrates, has an Assurance of Animal Care Form, Institutional Animal Care and Use Committee approval (or equivalent) been completed?

Attach Form:

Is Form Attached?

Does project require personnel to stay overnight at the Field Station?

If yes, how many nights?

List known persons in overnight stay:

Specifically describe all major instrumentation/equipment/gear and materials used, if applicable or required:

Provide details and schedule for the installation of instrumentation:

Provide details and schedule for the removal of instrumentation:

If instrumentation is permanent, describe need:

If instrumentation requires a maintenance schedule, describe needs and schedule:

Provide a data collection schedule:

Do you have a Safety Plan?

Attach Safety Plan:

Is Safety Plan Attached?

Describe plan for onsite and/or living accommodations:

Describe need and plan for onsite storage: