CBNERR-VA Research Permit
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Email *
1a. Name *
1b. Organization/Address *
1c. Phone Number *
2. Project Title *
3a. Estimated Project Start Date *
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YYYY
3b. Estimated Project End Date *
MM
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DD
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YYYY
4. Source(s) of funding *
5a. Research will be conducted at the following site(s): *
Required
5b. Estimated frequency of use at each reserve (days/yr) *
6. Requested duration of permit *
7. Brief Description of Project *
8. Types of Samples to be Collected *
9. Field Methodology *
10. Sample Collection Schedule *
11. Study Site Locations within each Reserve Site *
12. Potential short-term and long-term impacts on reserve system *
13. Final Products/Deliverables *
Name and Date (Signature) *
In return for permission to conduct research activities at CBNERRVA sites, I agree to deposit with CBNERRVA/VIMS, without charge, a copy of all reports, charts, publications, etc., derived from this work within one year of completion. (Please type your name and date to represent your signature to acknowledge your understanding and agreement with this request). You may continue to edit your form after submission.
A copy of your responses will be emailed to the address you provided.
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