Fillable APPLICATION FOR WEST VIRGINIA SCIENTIFIC COLLECTING PERMIT (West Virginia Division of Natural Resources)

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APPLICATION FOR WEST VIRGINIA SCIENTIFIC COLLECTING PERMIT (West Virginia Division of Natural Resources)

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APPLICATION FOR WEST VIRGINIA SCIENTIFIC COLLECTING PERMIT
Name:_______________________________________________________________________
Institution\Affiliation:____________________________________________________________
Street:_______________________________________________________________________
City:______________________________ State:__________ Zip:______________________
Telephone:________________________ Email: ___________________________________
Profession:________________________ Major professor: ___________________________
Specific manner of collection ____________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Purpose for which specimens are to be collected (include project name; attach project
proposal): ___________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
How will specimens be disposed? _________________________________________________
____________________________________________________________________________
Date on which collecting is to be: _______________________ _________________________
(Commence) (Terminate)
County(s) & nearest town(s): _____________________________________________________
____________________________________________________________________________
____________________________________________________________________________
If aquatic, indicate stream(s) and nearest town(s): ____________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Attach separate pages if additional space is required.
(Over)
Report, publication or thesis that will result from studies and additional comments or information
which may be pertinent to issuing this permit: ________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Have you received a WV permit in previous years? ________ Most recent year ___________
SPECIES TO BE COLLECTED OR HANDLED
SCIENTIFIC NAME
GENUS SPECIES NUMBER
_________________________________________________________ _________________
________________________________________________________ _________________
________________________________________________________ _________________
________________________________________________________ _________________
________________________________________________________ _________________
________________________________________________________ _________________
________________________________________________________ _________________
________________________________________________________ _________________
________________________________________________________ _________________
________________________________________________________ _________________
________________________________________________________ _________________
Where will vouchered specimens be deposited? _____________________________________
____________________________________________________________________________
____________________________________________________________________________
Signature Date
Send application to: Scientific Collecting Permit
Wildlife Resources
P.O. Box 67, 738 Ward Road
Elkins, WV 26241
barbara.d.sargent@wv.gov
11/2019
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APPLICATION FOR WEST VIRGINIA SCIENTIFIC COLLECTING PERMIT (West Virginia Division of Natural Resources)

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Completed 1 November 2020

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