Permit and Licensing Screening Form
Please fill out this form prior to start of any research project
Name
*
First Name
Last Name
Email
*
example@example.com
Name of Principle Investigator (Scientist)
*
What is the title of your research project?
*
What is the closest city, state, country to your research site?
*
What is the land ownership of your research site?
*
Onsite, Cary Institute (Millbrook Campus)
Federal Land or Water
State Land or Water
Private Land or Water
Other
What is your target start date?
*
-
Month
-
Day
Year
Date
Please provide a brief description of your research project. (Include research plan/methods)
*
0/250
Have you obtained permission from the owner for your research site?
*
Yes (Please upload a copy of permission below excluding Cary Property.)
No
Permission pending or in process
Unknown or I am not sure how or where to obtain permission
Will you be applying any of the following:
*
Algicide, Insecticide, Fungicide, Biocide, Rodenticide, Plant Growth Regulator and etc.
Chemical Tracers (i.e. dyes or stable isotopes)
Nutrients
Other Chemicals
Other not listed above
None
Do you have the proper approvals to apply the treatments listed above?
*
Yes (Please upload a copy of permission below.)
No
Permission pending or is in process
Unknown or I am not sure how or where to obtain permission
Not Applicable to my research
Are you collecting or handling any of the following (Please check all that apply):
*
Invertebrates
Vertebrates
Soil
Plants
Water
Protected, Endangered, or Threatened Plants or Animals
None of the above
Other not listed above
If you are collecting or handling organisms or samples that contain organisms, will your research involve any of the following (Please check all that apply):
*
Trapping, marking, catch and release, or banding of any organism
Collection of invasive species
Collection of organisms which may be vectors or may be carrying pathogens
Other not listed
None of the above
Do you have proper approval to collect or handle organisms or samples that contain organisms?
*
Yes (Please upload a copy of approval below excluding Cary Institute NYS DEC collection permit.)
No
Permission pending or is in process
Unknown or I am not sure how or where to obtain permission
Not Applicable to my research
Will you be transporting, shipping and/or receiving samples/organisms across borders (Please check all that apply):
*
Counties within the same State
Different States
Different Countries
No transport beyond county, state or country lines
Do you have the proper approvals to transport, ship and/or receive samples/organisms?
*
Yes (Please upload a copy of permission below.)
No
Permission pending or is in process
Unknown or I am not sure how or where to obtain permission
Not applicable to my research
Will you be holding, housing, rearing or containing any of the organisms or samples with your research?
*
Yes
No
Unknown
If you answered "yes" to the question above, where will you be holding, housing, rearing, or containing the organisms or samples?
Rearing Facility
Head House
Insectary
Greenhouse
Stream Facility
Molecular Lab
TESB Lab
Likens Lab
Other Cary Site, Not listed above
Not at Cary Institute, Millbrook, NY
Will you be working with human subjects?
*
Yes
Not Applicable
Will you be transporting or shipping research equipment or materials outside of the U.S.?
*
Yes
Not Applicable
Please upload a copy of any permissions granted, permits received or any other helpful information below. All information will be stored and made available to institutional staff as needed.
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