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: New Renewal Modification Other Principal Investigator First Name: Last Name: Attach Curriculum Vitae or Resume: Is Curriculum Vitae or Resume Attached? No Yes 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? No Yes 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? No Yes N/A 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? No Yes N/A Attach Form: Is Form Attached? No Yes Does project require personnel to stay overnight at the Field Station? No Yes 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? No Yes Attach Safety Plan: Is Safety Plan Attached? No Yes Describe plan for onsite and/or living accommodations: Describe need and plan for onsite storage:
