Illinois Department of Natural Resources
Scientific Permit Application


PERSONAL INFORMATION

First Name:         Last Name:     

Birthdate:          

Organization:

Mailing Address:      City:     

State:      ZipCode:  

Daytime Phone Number:      E-Mail:      


PERMIT INFORMATION

Most recent IDNR Scientific Collector Permit Number if applicable:

U.S. Fish and Wildlife Service Permits:

   Master Permittee:    Permit Number:

Type of Permit Requested:
 

Permit holders granted authorization under 520 ILCS 5/3.22 and 515 ILCS 5/20-100 of the Illinois Compiled Statutes and 17 ILL. Adm. Code 520 may handle species not listed as endangered or threatened in Illinois. Additional permission and/or permits may be needed to conduct research on sites owned or managed by the Illinois Department of Natural Resources or the Illinois Nature Preserve Commission. If you select “yes” to one or more of the following three questions, then additional permits may be needed.

      Will the project involve species listed as state endangered or threatened? (Yes/No)  
      Will the project occur on IDNR property? (Yes/No)  
      Will the project occur on Illinois Nature Preserve Commission sites? (Yes/No)   


Other individuals to be covered by this permit:


Will these additional individuals be working:
      Under direct supervision of the permittee? (Yes/No)     Independently of permittee? (Yes/No)  
      


APPLICANT QUALIFICATIONS

Highest Degree Earned:      Degree Institution:  
                                               

Degree Year:          Major:
 

Current Work Position Information:  

   Work Position:      Job Title:      Work Institution:    

   Employment Dates:     
 

Species Handled:


Other qualifications that relate to the permit request:



DESCRIPTION OF PROJECT

Title of Project:
 

Duration of Project:
 

Is your project directed or funded by IDNR? (Yes/No)  

If yes, what is the IDNR Contract or Grant Number or Project Name:

Description of the project including common names of species targeted and why the project is proposed:


 

Describe the Monitoring, Sampling, or Collecting Procedures to be used:


 

Disposition of Collected or Salvaged Specimens:


 

By submitting this application, I hereby certify that all statements made are correct to the best of my knowledge