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Application For Scientific Collection Permit
Application For Scientific Collection Permit
00 per year
Make Check Payable to DEEP
CHECK ONE:
New Study
without changes
Address:____________________________________________________________________________________________ City:________________________________________________ State: _______ Zip Code: ________________________ Phone: Work_________________________________ Home: _______________________________________________ Fax Number: ___________________________________ Email: _____________________________________________ TIME PERIOD OF STUDY: ____________________________________ to ____________________________________
(Note: A permit may be issued for a period of up to three years.)
LOCATION OF STUDY: (Please be as specific as possible and list any lands that are state owned. If it is a state property you must also submit a corresponding map detailing your study area and list any permanent markers that will used.) ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ SPECIES TO BE STUDIED including an estimated # of each species that will be collected, handled, marked or salvage:
ADDITIONAL FORMS REQUIRED: Please attach a project proposal which includes a detailed description of your methodology along with a Resume, List of references, Copy of Relevant Federal Permits, Animal Care & Use Committee approval when applicable, and the Names and titles of all Subpermittees. LIST ESTIMATED NUMBER OF EACH SPECIES THAT WILL BE HANDLED, MARKED, COLLECTED, SALVAGED ETC
Applicants Signature
Date
Rev. 7/2011
Page 1 of 3
STUDY DESCRIPTION:
Rev. 7/2011
Page 2 of 3
Rev. 7/2011