Jobs: Scientific Research - Permit

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PERMIT NUMBER____________

DATE ISSUED _______________

North Carolina Division of Parks and Recreation
Scientific Research and Collecting Permit

Please print or type legibly. Incomplete or illegible applications will be returned.

1. Principal Investigator

Name:_______________________________________________________

Institutional Affiliation:__________________________________________

Address: _____________________________________________________

____________________________________________________________

Phone: ________________________ e-mail: ________________________

2. Project Director or Major Advisor (If Applicable)

Name:_______________________________________________________

Institutional Affiliation:_________________________________________

Address: ______________________________________________

_______________________________________________________

Phone: ________________________ e-mail: ________________________

3. Park Unit(s) Where Research is to be Performed:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

4. Research Schedule:

Field work: Start Date_____________________ Ending Date____________________

Total project: Start Date_____________________ Ending Date____________________

5. Attach a Detailed Project Description. Include:

1. Resume/vita of the Principal Investigator and Project Director. If not apparent from your resume, briefly state your experience and qualifications in the area of proposed research.

2. A project synopsis, including purpose (graduate thesis, independent study, etc.), specific objectives and complete methodology. If applicable, include a species list and the name and address of the proposed curatorial facility. If your project involves ground disturbance, estimate the amount, location and duration.

3. Clearly marked USGS topographic maps (1:24,000) or park brochure maps showing proposed study areas. USGS maps must show the quad name. For information on USGS maps, contact the N.C. Geological Survey Sales Office at (919) 715-9718.

4. A list of other required permits and proof of possession.

NOTE TO THE APPLICANT:

• The permittee must notify the park superintendent prior to initiating any research activities.
• This permit may be used only by the person(s) to whom it is issued.
• Principal investigators will provide the division with two copies of a research report within 60 days of the project's conclusion and two reprints of any publication resulting from studies conducted on state park property. An annual report, due on December 31, is required for any project exceeding one year. Reports are to address the project's goals, methodology, results and conclusions. Progress reports may also be specified as a condition of the permit. The reporting requirement may be waived for classes that use a park as an outdoor classroom.
• This permit is issued subject to the conditions specified below. The permittee shall and hereby does waive and release any and all claim against the North Carolina Department of Environment and Natural Resources, or its employees, or the State of North Carolina for any and all damages, loss or cost to person or property arising either directly or indirectly from the use of said premises and/or from the exercise of the privileges granted by this permit.

______________________________________________

Signature of Principal Investigator : Date

=========================================

FOR ADMINISTRATIVE USE ONLY

Date Received:_________________

Approved by:_____________________________________

Staff Coordinator:_________________________________

Comments/Conditions:_____________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________