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# DIRECCION GENERAL DE VIDA SILVESTRE

**Formato de solicitud para la expedición del permiso especial de
investigación y/o colecta con fines científicos de flora y fauna
silvestre y otros recursos biológicos para investigadores nacionales y
extranjeros.**

+-----------------------------------------------------------------------+
| Los investigadores nacionales, deberán enviar este formato acompañado |
| de carta solicitud y demás documentación a:                           |
|                                                                       |
| Dirección General de Vida Silvestre                                   |
|                                                                       |
| Av. Revolución No. 1425, Ventanilla Unica de Vida Silvestre           |
|                                                                       |
| Col. Tlacopac, Deleg. Alvaro Obregón                                  |
|                                                                       |
| C.P. 01040, México D.F.                                               |
|                                                                       |
| Los investigadores extranjeros, pueden enviar este formato acompañado |
| del resto de los requisitos a través de la Representación Diplomática |
| de su país en México.                                                 |
+-----------------------------------------------------------------------+
| **I. DATOS DEL SOLICITANTE**                                          |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
|                                                                       |
| Apellido paterno Apellido materno Nombre (s)                          |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                    |
|                                                                       |
| R.F.C. Cédula profesional                                             |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_                                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Institución                                                           |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_                                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Domicilio                                                             |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                                       |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Teléfono y fax Fecha de solicitud                                     |
|                                                                       |
| \                                                                     |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                      |
|                                                                       |
| Correo electrónico Número y Fecha del Registro Nacional               |
|                                                                       |
| de Colector Científico                                                |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_          |
|                                                                       |
| En el caso de ser investigadores extranjeros, mencionar la            |
| Institución Contraparte Científica Mexicana y anexar original de      |
| carta aval.                                                           |
+-----------------------------------------------------------------------+
| **II. TIPO DE SOLICITUD**                                             |
|                                                                       |
| Aval de investigación científica Permiso de colecta definitiva        |
|                                                                       |
| Permiso de captura temporal Otro(s) especificar:                      |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                      |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\                                                   |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Tipo de apoyo con que cuenta el proyecto: CONACYT CONABIO             |
|                                                                       |
| Otro(s) especificar: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                 |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\                                                   |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| **III. RESUMEN EJECUTIVO DEL PROYECTO**                               |
|                                                                       |
| Título del proyecto:                                                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\   |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Objetivo del proyecto:                                                |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\         |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Justificación del proyecto:                                           |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\               |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Descripción breve de la metodología:                                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                               |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Pretende colectar:                                                    |
|                                                                       |
| Terrestre Terrestre                                                   |
|                                                                       |
| Flora: Acuática Fauna: Acuática                                       |
|                                                                       |
| Individuos vivos Individuos muertos                                   |
|                                                                       |
| Ejemplares completos Partes o muestras                                |
|                                                                       |
| Otro(s) Especificar:                                                  |
| \_\_\_\_\_\_\_\_\_\_\_\_\                                             |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Especies y No. de ejemplares, partes o muestras por especie (cuando   |
| no sea posible especificar la(s) especie(s), indicar género o         |
| familia; para el caso de proyectos sobre inventarios y prospecciones, |
| especificar género o familia de interés; anexar hojas de ser          |
| necesario):                                                           |
|                                                                       |
| Nombre científico Nombre común Cantidad a colectar                    |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                  |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                  |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                  |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                  |
|                                                                       |
| Sitios de investigación, captura o colecta (anexar hojas de ser       |
| necesario):                                                           |
|                                                                       |
| Estado Municipio Localidad                                            |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                  |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                  |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                  |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                  |
|                                                                       |
| Periodo(s) de inicio y término de la investigación (día/mes/año):     |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_      |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------------------------------------------+
| **IV. DESTINO DEL MATERIAL COLECTADO**                                |
|                                                                       |
| Destino final del material colectado:                                 |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\                               |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_                                        |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\ |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
|                                                                       |
| Si el desarrollo del proyecto implica la exportación del material     |
| colectado, mencione:                                                  |
|                                                                       |
| Exportación temporal Exportación definitiva                           |
|                                                                       |
| Aduana(s) por la que sale:                                            |
| \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Fecha probable de  |
| salida: \_\_\_\_\_\_\_\_\_\_\_\_\_\_                                  |
|                                                                       |
| Sitio y tiempo que permanecerá en el extranjero (sólo exportación     |
| temporal): \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_             |
|                                                                       |
| Nota: toda solicitud de exportación de material biológico, también    |
| deberá ser tramitada en esta Dirección General.                       |
+-----------------------------------------------------------------------+

+-----------------------------------------------------------------------+
| Para efectos estadísticos, se solicita contestar estas preguntas:     |
|                                                                       |
| ¿Cómo clasificaría su trabajo en base ¿Cuál considera que será la     |
| aplicación de su trabajo?                                             |
|                                                                       |
| a la actividad que desarrolla?                                        |
|                                                                       |
| Inventario florístico IFO Conservación CNS                            |
|                                                                       |
| Inventario faunístico IFA Etnobotánica ETB                            |
|                                                                       |
| Ecología de poblaciones EPO Conocimiento de la biodiversidad BDV      |
|                                                                       |
| Sistemática y taxonomía SIT Alternativa productiva APA                |
|                                                                       |
| Fisiología de la reproducción FRE Aplicación biotecnológica BTC       |
|                                                                       |
| Fisiología FIS                                                        |
+-----------------------------------------------------------------------+
| Crucero oceanográfico (geofísica) CGE                                 |
|                                                                       |
| Crucero oceanográfico (comunidades marinas) CCM                       |
+-----------------------------------------------------------------------+

**BAJO PROTESTA DE DECIR VERDAD MANIFIESTO QUE LA COLECTA CIENTÍFICA A
REALIZAR NO SERA UTILIZADA CON FINES DE BIOTECNOLOGIA**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Nombre y firma del solicitante**

**DOCUMENTACION QUE DEBE ACOMPAÑAR A ESTE FORMATO**

1\. Carta de solicitud del titular de la institución a la que pertenece
el investigador responsable.

2\. Curriculum vitae del investigador responsable.

3\. Copia del proyecto a desarrollar en extenso.

4\. De contar con ella y si se reporta en el formato, anexar copia de la
carta de aceptación del S.N.I.

5\. Formato correctamente completado, anexando y de ser insuficientes
los espacios, hojas adicionales.

6\. De ser posible y en caso de que se realicen colectas en un Area
Natural Protegida, deberá remitir la opinión técnica del Director del
Area Natural Protegida correspondiente.

**Notas aclaratorias**

El entregar y requisitar la presente solicitud, únicamente dará derecho
a la evaluación de la misma, sin la obligación de la autoridad
competente de otorgar el permiso.

En caso de no recibirse completa la información solicitada o estar
indebidamente requisitada la solicitud, será devuelta sin derecho de
evaluación.

La autoridad competente dará respuesta a la solicitud en un plazo no
mayor de 21 días hábiles a partir de la fecha de recepción.

Toda documentación enviada, pasará a formar parte de los expedientes de
esta Dirección General, tendrá uso exclusivo de evaluación con carácter
confidencial.

Si hubiera cambio en los datos personales, laborales o profesionales,
deberá notificarlo inmediatamente a la Dirección General de Vida
Silvestre.

Anexe hojas si los espacios de la solicitud le son insuficientes.

**PARA MAYOR INFORMACION**

Tels. 6 24 36 54

6 24 36 53

Fax. 6 24 35 88

Correo electrónico del Departamento de Coordinación de Centros
Integrales de Vida Silvestre.

<dmorales@ine.gob.mx>

<mcobian@ine.gob.mx>

<pdiaz@ine.gob.mx>

**U.S. Department of State**

**Office of Language Services**

**Translating Division**

> LS No. 0410191\
> JPM/ML\
> Spanish
>
> Department of the Environment and Natural Resources

**Bureau of Wildlife**

**Special Application Form for Mexican and Foreign Researchers to
Conduct\
Research and/or to Collect Wild Animal and Plant Life\
and Other Biological Resources for Scientific Purposes**

<table>
<colgroup>
<col style="width: 10%" />
<col style="width: 19%" />
<col style="width: 2%" />
<col style="width: 0%" />
<col style="width: 16%" />
<col style="width: 12%" />
<col style="width: 4%" />
<col style="width: 0%" />
<col style="width: 19%" />
<col style="width: 9%" />
<col style="width: 3%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="11">Mexican researchers should submit this form, together
with an application letter and other documentation, to:</td>
</tr>
<tr class="even">
<td></td>
<td colspan="8">Dirección General de Vida Silvestre<br />
Av. Revolución No. 1425, Ventanilla Única de Vida Silvestre<br />
Col. Tlacopac, Deleg. Álvaro Obregón<br />
C.P. 01040, Mexico, D.F.</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="11">Foreign researchers may submit this form, together with
the other required documents, through their country’s diplomatic mission
in Mexico</td>
</tr>
<tr class="even">
<td colspan="4"><strong>I. Applicant Data</strong></td>
<td colspan="3"></td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="2"></td>
<td colspan="2"></td>
<td></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="2">Paternal surname</td>
<td colspan="2"></td>
<td colspan="2">Maternal surname</td>
<td></td>
<td colspan="3">Given name(s)</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="2">R.F.C. [taxpayer ID No.]</td>
<td colspan="2"></td>
<td colspan="2">Professional ID No.</td>
<td></td>
<td colspan="3"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="4">Institutional affiliation</td>
<td colspan="3"></td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="4">Home address</td>
<td colspan="3"></td>
<td colspan="4"></td>
</tr>
<tr class="even">
<td colspan="3">Telephone and fax</td>
<td colspan="5"></td>
<td colspan="3">Application date</td>
</tr>
<tr class="odd">
<td colspan="3">E-mail address</td>
<td colspan="5"></td>
<td colspan="3">National Scientific Collector Registration number and
date</td>
</tr>
<tr class="even">
<td colspan="11">For foreign researchers, please mention the counterpart
Mexican scientific institution and attach an original letter of
endorsement.</td>
</tr>
<tr class="odd">
<td colspan="11"><strong>II. Type of Application</strong></td>
</tr>
<tr class="even">
<td colspan="5">Endorsement of scientific research □</td>
<td colspan="6">Permission for permanent collection □</td>
</tr>
<tr class="odd">
<td colspan="5">Permission for temporary capture □</td>
<td colspan="6">Other □ please specify ___________________________<br />
_____________________________________________________</td>
</tr>
<tr class="even">
<td colspan="5">Type of project support:</td>
<td colspan="6"><p>CONACYT [National Council for Science and Technology]
□<br />
CONABIO [National Commission for Biodiversity □<br />
Knowledge and Use]</p>
<p>Other □ please specify __________<br />
______________________________________</p></td>
</tr>
</tbody>
</table>

+-------------+---+---+-------------+---+-----+------+------+---------+
| **III.      |   |   |             |   |     |      |      |         |
| Executive   |   |   |             |   |     |      |      |         |
| Summary of  |   |   |             |   |     |      |      |         |
| the         |   |   |             |   |     |      |      |         |
| Project**   |   |   |             |   |     |      |      |         |
+-------------+---+---+-------------+---+-----+------+------+---------+
| Title of    |   |   |             |   |     |      |      |         |
| the         |   |   |             |   |     |      |      |         |
| project:    |   |   |             |   |     |      |      |         |
| \_\         |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
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| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| \_          |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
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| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| Purpose of  |   |   |             |   |     |      |      |         |
| the         |   |   |             |   |     |      |      |         |
| project:    |   |   |             |   |     |      |      |         |
| \_\_\_\_    |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| \_          |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| Ju          |   |   |             |   |     |      |      |         |
| stification |   |   |             |   |     |      |      |         |
| for the     |   |   |             |   |     |      |      |         |
| project:    |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| \_          |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| Brief       |   |   |             |   |     |      |      |         |
| description |   |   |             |   |     |      |      |         |
| of          |   |   |             |   |     |      |      |         |
| m           |   |   |             |   |     |      |      |         |
| ethodology: |   |   |             |   |     |      |      |         |
| \           |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| \_          |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| Seeking to  |   |   |             |   |     |      |      |         |
| collect:    |   |   |             |   |     |      |      |         |
+-------------+---+---+-------------+---+-----+------+------+---------+
| Flora:      |   | L |             | F |     |      | Land |         |
|             |   | a |             | a |     |      | □    |         |
|             |   | n |             | u |     |      |      |         |
|             |   | d |             | n |     |      |      |         |
|             |   | □ |             | a |     |      |      |         |
|             |   |   |             | : |     |      |      |         |
+-------------+---+---+-------------+---+-----+------+------+---------+
|             |   | W |             |   |     |      | W    |         |
|             |   | a |             |   |     |      | ater |         |
|             |   | t |             |   |     |      | □    |         |
|             |   | e |             |   |     |      |      |         |
|             |   | r |             |   |     |      |      |         |
|             |   | □ |             |   |     |      |      |         |
+-------------+---+---+-------------+---+-----+------+------+---------+
| Live        |   | D |             |   |     |      |      |         |
| specimens □ |   | e |             |   |     |      |      |         |
|             |   | a |             |   |     |      |      |         |
| Complete    |   | d |             |   |     |      |      |         |
| specimens □ |   | s |             |   |     |      |      |         |
|             |   | p |             |   |     |      |      |         |
|             |   | e |             |   |     |      |      |         |
|             |   | c |             |   |     |      |      |         |
|             |   | i |             |   |     |      |      |         |
|             |   | m |             |   |     |      |      |         |
|             |   | e |             |   |     |      |      |         |
|             |   | n |             |   |     |      |      |         |
|             |   | s |             |   |     |      |      |         |
|             |   | □ |             |   |     |      |      |         |
|             |   |   |             |   |     |      |      |         |
|             |   | P |             |   |     |      |      |         |
|             |   | a |             |   |     |      |      |         |
|             |   | r |             |   |     |      |      |         |
|             |   | t |             |   |     |      |      |         |
|             |   | s |             |   |     |      |      |         |
|             |   | o |             |   |     |      |      |         |
|             |   | r |             |   |     |      |      |         |
|             |   | s |             |   |     |      |      |         |
|             |   | a |             |   |     |      |      |         |
|             |   | m |             |   |     |      |      |         |
|             |   | p |             |   |     |      |      |         |
|             |   | l |             |   |     |      |      |         |
|             |   | e |             |   |     |      |      |         |
|             |   | s |             |   |     |      |      |         |
|             |   | □ |             |   |     |      |      |         |
+-------------+---+---+-------------+---+-----+------+------+---------+
| Other □     |   | P |             |   |     |      |      |         |
|             |   | l |             |   |     |      |      |         |
|             |   | e |             |   |     |      |      |         |
|             |   | a |             |   |     |      |      |         |
|             |   | s |             |   |     |      |      |         |
|             |   | e |             |   |     |      |      |         |
|             |   | s |             |   |     |      |      |         |
|             |   | p |             |   |     |      |      |         |
|             |   | e |             |   |     |      |      |         |
|             |   | c |             |   |     |      |      |         |
|             |   | i |             |   |     |      |      |         |
|             |   | f |             |   |     |      |      |         |
|             |   | y |             |   |     |      |      |         |
|             |   | : |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
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|             |   | _ |             |   |     |      |      |         |
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|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
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|             |   | _ |             |   |     |      |      |         |
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|             |   | _ |             |   |     |      |      |         |
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|             |   | _ |             |   |     |      |      |         |
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|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
|             |   | \ |             |   |     |      |      |         |
|             |   | _ |             |   |     |      |      |         |
+-------------+---+---+-------------+---+-----+------+------+---------+
| Species and |   |   |             |   |     |      |      |         |
| number of   |   |   |             |   |     |      |      |         |
| specimens,  |   |   |             |   |     |      |      |         |
| parts, or   |   |   |             |   |     |      |      |         |
| samples per |   |   |             |   |     |      |      |         |
| species     |   |   |             |   |     |      |      |         |
| (when it is |   |   |             |   |     |      |      |         |
| not         |   |   |             |   |     |      |      |         |
| possible to |   |   |             |   |     |      |      |         |
| specify the |   |   |             |   |     |      |      |         |
| species,    |   |   |             |   |     |      |      |         |
| please      |   |   |             |   |     |      |      |         |
| indicate    |   |   |             |   |     |      |      |         |
| the genus   |   |   |             |   |     |      |      |         |
| or family;  |   |   |             |   |     |      |      |         |
| for each    |   |   |             |   |     |      |      |         |
| inventory   |   |   |             |   |     |      |      |         |
| and survey  |   |   |             |   |     |      |      |         |
| project,    |   |   |             |   |     |      |      |         |
| please      |   |   |             |   |     |      |      |         |
| specify the |   |   |             |   |     |      |      |         |
| genus and   |   |   |             |   |     |      |      |         |
| family of   |   |   |             |   |     |      |      |         |
| interest;   |   |   |             |   |     |      |      |         |
| attach      |   |   |             |   |     |      |      |         |
| additional  |   |   |             |   |     |      |      |         |
| pages, if   |   |   |             |   |     |      |      |         |
| necessary:  |   |   |             |   |     |      |      |         |
+-------------+---+---+-------------+---+-----+------+------+---------+
| Scientific  |   |   | Common      |   |     | Am   |      |         |
| name\       |   |   | name\       |   |     | ount |      |         |
| \           |   |   | \           |   |     | to   |      |         |
| \_\_\_\_\_  |   |   | \_\_\_\_\   |   |     | be   |      |         |
| \_\_\_\_\_\ |   |   | _\_\_\_\_\_ |   |     | co   |      |         |
| _\_\_\_\_\_ |   |   | \_\_\_\_\_\ |   |     | llec |      |         |
| \_\_\_\_\_\ |   |   | _\_\_\_\_\_ |   |     | ted\ |      |         |
| \_\_\_\_\_  |   |   | \_\_\_\_\_\ |   |     | \    |      |         |
| \_\_\_\_\_\ |   |   | \_\_\_\_\   |   |     | \    |      |         |
| _\_\_\_\_\_ |   |   | _\_\_\_\_\_ |   |     | _\_\ |      |         |
| \_\_\_\_\_\ |   |   | \_\_\_\_\_\ |   |     | _\_\ |      |         |
| \_\_\_\_\_  |   |   | _\_\_\_\_\_ |   |     | _\_\ |      |         |
| \_\_\_\_\_\ |   |   | \_\_\_\_\_\ |   |     | _\_\ |      |         |
| _\_\_\_\_\_ |   |   | \_\_\_\_\   |   |     | _\_\ |      |         |
| \_\_\_\_\_\ |   |   | _\_\_\_\_\_ |   |     | _\_\ |      |         |
| \_\_\_\_\   |   |   | \_\_\_\_\_\ |   |     | _\_\ |      |         |
| _\_\_\_\_\_ |   |   | _\_\_\_\_\_ |   |     | _\_\ |      |         |
| \_\_\_\_\_\ |   |   | \_\_\_\_\_\ |   |     | _\_\ |      |         |
| _\_\_\_\_\_ |   |   | \_\_\_\_    |   |     | _\_\ |      |         |
|             |   |   | \_\_\_\_\_\ |   |     | _\_\ |      |         |
|             |   |   | _\_\_\_\_\_ |   |     | \    |      |         |
|             |   |   | \_\_\_\_\_\ |   |     | _\_\ |      |         |
|             |   |   | _\_\_\_\_\_ |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | \    |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
+-------------+---+---+-------------+---+-----+------+------+---------+
| Research,   |   |   |             |   |     |      |      |         |
| capture, or |   |   |             |   |     |      |      |         |
| collection  |   |   |             |   |     |      |      |         |
| sites       |   |   |             |   |     |      |      |         |
| (attach     |   |   |             |   |     |      |      |         |
| additional  |   |   |             |   |     |      |      |         |
| pages if    |   |   |             |   |     |      |      |         |
| necessary)  |   |   |             |   |     |      |      |         |
+-------------+---+---+-------------+---+-----+------+------+---------+
| State\      |   |   | Mu          |   |     | Loc  |      |         |
| \           |   |   | nicipality\ |   |     | ale\ |      |         |
| \           |   |   | \           |   |     | \    |      |         |
| \_\_\_\_\_  |   |   | \           |   |     | \    |      |         |
| \_\_\_\_\_\ |   |   | \_\_\_\_\   |   |     | \_\  |      |         |
| _\_\_\_\_\_ |   |   | _\_\_\_\_\_ |   |     | _\_\ |      |         |
| \_\_\_\_\_\ |   |   | \_\_\_\_\_\ |   |     | _\_\ |      |         |
| \_\_\_\_\_  |   |   | _\_\_\_\_\_ |   |     | _\_\ |      |         |
| \_\_\_\_\_\ |   |   | \_\_\_\_\_\ |   |     | _\_\ |      |         |
| _\_\_\_\_\_ |   |   | \_\_\_\_\   |   |     | _\_\ |      |         |
| \_\_\_\_\_\ |   |   | _\_\_\_\_\_ |   |     | _\_\ |      |         |
| \_\_\_\_\_  |   |   | \_\_\_\_\_\ |   |     | _\_\ |      |         |
| \_\_\_\_\_\ |   |   | _\_\_\_\_\_ |   |     | _\_\ |      |         |
| _\_\_\_\_\_ |   |   | \_\_\_\_\_\ |   |     | _\_\ |      |         |
| \_\_\_\_\_\ |   |   | \_\_\_\_\   |   |     | _\_\ |      |         |
| \_\_\_\_\   |   |   | _\_\_\_\_\_ |   |     | _\_\ |      |         |
| _\_\_\_\_\_ |   |   | \_\_\_\_\_\ |   |     | \_\  |      |         |
| \_\_\_\_\_\ |   |   | _\_\_\_\_\_ |   |     | _\_\ |      |         |
| _\_\_\_\_\_ |   |   | \_\_\_\_\_\ |   |     | _\_\ |      |         |
|             |   |   | \_\_\_\_    |   |     | _\_\ |      |         |
|             |   |   | \_\_\_\_\_\ |   |     | _\_\ |      |         |
|             |   |   | _\_\_\_\_\_ |   |     | _\_\ |      |         |
|             |   |   | \_\_\_\_\_\ |   |     | _\_\ |      |         |
|             |   |   | _\_\_\_\_\_ |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | \_\  |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | _\_\ |      |         |
|             |   |   |             |   |     | \_   |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
|             |   |   |             |   |     | \_\_ |      |         |
+-------------+---+---+-------------+---+-----+------+------+---------+
| Day         |   |   |             |   |     |      |      |         |
| /month/year |   |   |             |   |     |      |      |         |
| the         |   |   |             |   |     |      |      |         |
| research    |   |   |             |   |     |      |      |         |
| begins and  |   |   |             |   |     |      |      |         |
| ends        |   |   |             |   |     |      |      |         |
| \_\_        |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
+-------------+---+---+-------------+---+-----+------+------+---------+
| **IV.       |   |   |             |   |     |      |      |         |
| Destination |   |   |             |   |     |      |      |         |
| of          |   |   |             |   |     |      |      |         |
| Collected   |   |   |             |   |     |      |      |         |
| Material**  |   |   |             |   |     |      |      |         |
|             |   |   |             |   |     |      |      |         |
| Final       |   |   |             |   |     |      |      |         |
| destination |   |   |             |   |     |      |      |         |
| of          |   |   |             |   |     |      |      |         |
| collected   |   |   |             |   |     |      |      |         |
| material:   |   |   |             |   |     |      |      |         |
| \_\_        |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| \_          |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| \           |   |   |             |   |     |      |      |         |
| If the      |   |   |             |   |     |      |      |         |
| project     |   |   |             |   |     |      |      |         |
| involves    |   |   |             |   |     |      |      |         |
| the         |   |   |             |   |     |      |      |         |
| exportation |   |   |             |   |     |      |      |         |
| of          |   |   |             |   |     |      |      |         |
| collected   |   |   |             |   |     |      |      |         |
| material,   |   |   |             |   |     |      |      |         |
| please      |   |   |             |   |     |      |      |         |
| indicate:   |   |   |             |   |     |      |      |         |
|             |   |   |             |   |     |      |      |         |
| Temporary   |   |   |             |   |     |      |      |         |
| exportation |   |   |             |   |     |      |      |         |
| □ Permanent |   |   |             |   |     |      |      |         |
| exportation |   |   |             |   |     |      |      |         |
| □           |   |   |             |   |     |      |      |         |
|             |   |   |             |   |     |      |      |         |
| Customs     |   |   |             |   |     |      |      |         |
| office(s)   |   |   |             |   |     |      |      |         |
| through     |   |   |             |   |     |      |      |         |
| which the   |   |   |             |   |     |      |      |         |
| material    |   |   |             |   |     |      |      |         |
| will exit   |   |   |             |   |     |      |      |         |
| the         |   |   |             |   |     |      |      |         |
| country     |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| Probable    |   |   |             |   |     |      |      |         |
| date of     |   |   |             |   |     |      |      |         |
| exit:       |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
|             |   |   |             |   |     |      |      |         |
| Location of |   |   |             |   |     |      |      |         |
| material    |   |   |             |   |     |      |      |         |
| abroad and  |   |   |             |   |     |      |      |         |
| how long it |   |   |             |   |     |      |      |         |
| will be     |   |   |             |   |     |      |      |         |
| abroad      |   |   |             |   |     |      |      |         |
| (only for   |   |   |             |   |     |      |      |         |
| temporary   |   |   |             |   |     |      |      |         |
| export):    |   |   |             |   |     |      |      |         |
| \_\_\_      |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
| \_\_\_\_\_\ |   |   |             |   |     |      |      |         |
| _\_\_\_\_\_ |   |   |             |   |     |      |      |         |
|             |   |   |             |   |     |      |      |         |
| Note: All   |   |   |             |   |     |      |      |         |
| export      |   |   |             |   |     |      |      |         |
| a           |   |   |             |   |     |      |      |         |
| pplications |   |   |             |   |     |      |      |         |
| for         |   |   |             |   |     |      |      |         |
| biological  |   |   |             |   |     |      |      |         |
| materials   |   |   |             |   |     |      |      |         |
| must also   |   |   |             |   |     |      |      |         |
| be          |   |   |             |   |     |      |      |         |
| processed   |   |   |             |   |     |      |      |         |
| by this     |   |   |             |   |     |      |      |         |
| Bureau.     |   |   |             |   |     |      |      |         |
+-------------+---+---+-------------+---+-----+------+------+---------+

+--------------------------+---+---+----------------------+---------+---+
| For statistical          |   |   |                      |         |   |
| purposes, please answer  |   |   |                      |         |   |
| the following questions: |   |   |                      |         |   |
+--------------------------+---+---+----------------------+---------+---+
| Based on the kinds of    |   |   | To which of the      |         |   |
| activities you pursue,   |   |   | following would your |         |   |
| how would you classify   |   |   | work apply?          |         |   |
| your work?               |   |   |                      |         |   |
+--------------------------+---+---+----------------------+---------+---+
| Flora inventory IFO      | □ |   | Conservation CNS     | □\      |   |
|                          | \ |   |                      | □\      |   |
| Fauna inventory IFA      | □ |   | Ethnobotany ETB      | □\      |   |
|                          | \ |   |                      | □\      |   |
| Population ecology EPO   | □ |   | Biodiversity         | □       |   |
|                          | \ |   | knowledge BDV        |         |   |
| Systems studies and      | □ |   |                      |         |   |
| taxonomy SIT             | \ |   | Alternative          |         |   |
|                          | □ |   | production APA       |         |   |
| Physiology of            | \ |   |                      |         |   |
| reproduction FRE         | □ |   | Biotechnical         |         |   |
|                          | \ |   | applications BTC     |         |   |
| Physiology FIS           | □ |   |                      |         |   |
|                          | \ |   |                      |         |   |
| Oceanographic cruise     | □ |   |                      |         |   |
| (geophysical) CGE        |   |   |                      |         |   |
|                          |   |   |                      |         |   |
| Oceanographic cruise     |   |   |                      |         |   |
| (marine communities) CCM |   |   |                      |         |   |
+--------------------------+---+---+----------------------+---------+---+

**I hereby state, under penalty of perjury, that the scientific
collection work to be carried out\
will not be used for purposes of biotechnology**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Name and signature of applicant**

**This form must be accompanied by the following documentation:**

1\. Letter of application from the head of the institution with which
the head researcher is affiliated

2\. Curriculum vitae (CV) of the head researcher

3\. Copy of the detailed project description

4\. Copy of the SNI \[National Researcher System\] letter of approval,
if applicable and reported on the form

5\. This form, correctly completed, with appropriate attachments and
additional pages, where more space is needed

6\. Technical opinion of the pertinent Director of a Protected Natural
Area, where possible, when collection work will take place in such an
Area.

**Explanatory notes**

Applicants who complete and submit this application are entitled only to
its review; the authorities are under no obligation to grant the
permission sought.

Incomplete or incorrectly completed applications will be returned
unreviewed.

The authorities will respond to applications within 21 business days of
receipt.

All documentation sent will become part of the files of this Bureau,
will be used solely for review purposes, and will handled as
confidential information.

Any changes in personal or professional information must be reported
immediately to the Bureau of Wildlife.

Please attach additional pages if more space is needed.

**For more information**

Telephone: 6 24 36 54 and 6 24 36 53 Fax: 6 24 35 88\
E-mail addresses of the Coordinating Unit for Integrated Wildlife
Centers:\
<dmorales@ine.gob.mx>\
<mcobian@ine.gob.mx>\
<pdiaz@ine.gob.mx>