Forms • El Cerrito, CA • CivicEngage

Research Permit Application

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Application submission date*

Renewal? (If yes, list the previous permit #)*

Is your report attached to this application?

Yes

Affiliation*

Full name of person to be on permit*

Point of contact email address*

Telephone number*

Mailing address*

Name(s) of additional personnel to list on permit

Title of proposed research*

Date to begin proposed research (PLEASE ALLOW 8-10 WEEKS FOR PROCESSING)*

Will you require vehicle access in the park(s)? (*Please note this will require additional approval as well as a valid License and proof of Insurance. Requesting vehicle access may delay application processing.)

Yes

Will you require collection of any Flora or Fauna? (*Please Note: If you wish to collect any animal, including invertebrates, you must have and show proof of your current Scientific Collecting Permit from the California Department of Fish and Wildlife.)

Yes

Permit duration

	1 year permit
	3 year permit

5 year permit

Park(s) where research is to be conducted*

Specific location(s) of work within the park*

Scope of work (Include objectives and description of the proposed research, methods employed including special equipment, estimated timeline for the research project, estimated sample sizes required and copies of other permits e.g., Scientific Collecting Permit, if appropriate). [Please Note: If you wish to collect any animal, including invertebrates, you must have and show proof of your current Scientific Collecting Permit from the California Department of Fish and Wildlife.]*

FOR OFFICE USE ONLY

Student Permit fee - $25
Check #

Non-student permit fee - $50
Check #

Fee waived

Approvals:

* indicates required fields.

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