Individual/Agency making request:
(Required)
Point of contact (if different from above):
Address where work will be performed
(Required)
Street Address
Address Line 2
City
ZIP Code
Phone
(Required)
Email
(Required)
Please list all prohibited species to be utilized (use both scientific and common names):
(Required)
Purpose of use (check all that apply):
(Required)
Cultivation (water spinach only)
Educational
Research
Other (explain below)
Other (purpose of use)
(Required)
Summarize the work to be done:
(Required)
Will the work include plant propagules (seeds, rhizomes, or any other reproductive structures)?
(Required)
Where will you obtain the plant material?
(Required)
Describe the facility that will be used to do this work, particularly features that will ensure containment of the prohibited species. (Will the project be indoors or outdoors? Is the facility a “controlled facility”? Etc.):
(Required)
Describe how you will dispose of all plant material, particularly plant propagules, both during the project and when the project is complete, in order to prevent the prohibited species from being accidentally introduced into the natural environment:
(Required)
Describe any other issues that you believe were not covered in the questions above:
Annual Report
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I agree to the following:
(Required)
Permits are approved for one year cycles but can be renewed. Permit holders are required to provide MDAR with a report describing work completed at the end of each permit cycle. Permit holders may be periodically subject to site visits by MDAR inspectors.