This application is for a(n): New Permit Renewal Amendment To Existing Permit Previous Marine Turtle Permit Number:

Similar documents
APPLICATION FOR ADMINISTRATOR-IN-TRAINING NURSING HOME ADMINISTRATOR. (Please type or print; Answer all questions in full)

State of Florida Department of Health. Board of Osteopathic Medicine. Application for Registration as an Osteopathic Physician in Training

APPLICATION FOR RECIPROCAL LICENSE NURSING HOME ADMINISTRATOR

State of Florida Department of Health. Board of Osteopathic Medicine. Application for Registration as an Osteopathic Physician in Training

Florida Department of Corrections CORRECTIONAL PROBATION OFFICER SUPPLEMENTAL APPLICATION

RULES OF DEPARTMENT OF COMMERCE AND INSURANCE DIVISION OF REGULATORY BOARDS CHAPTER PRIVATE PROTECTIVE SERVICES TABLE OF CONTENTS

Employee Registration Information

SOUTH FLORIDA/CARIBBEAN COOPERATIVE ECOSYSTEM STUDIES UNIT AMENDMENT TWO TO COOPERATIVE AGREEMENT. between

Diocese of St. Augustine

New Jersey Motor Vehicle Commission

1. Project Information 1.1. Project Location: Northwest Corner of Dickman Road and Elsberry RoadApollo Beach, Florida in Hillsborough County

A Bill Regular Session, 2015 HOUSE BILL 1162

MISSOURI. Downloaded January 2011

APPLICATION FOR CERTIFICATION

Certified Recovery Support Practitioner (CRSP)

Text Facsimile of Online Medical Radiologic Technologist Application

Instructions and Resource Page for Application for a License to Operate a Child Care Facility

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing.

Application for Employment

Certified Dangerous Goods Trainer Application

APPLICATION CHECKLIST IMPORTANT

NORTH CAROLINA MARRIAGE AND FAMILY THERAPY LICENSURE BOARD

MAINE STATE BOARD OF NURSING

New Jersey Motor Vehicle Commission

CERTIFIED CLINICAL SUPERVISOR CREDENTIAL

RULES AND REGULATIONS FOR THE CERTIFICATION OF ADMINISTRATORS OF ASSISTED LIVING RESIDENCES (R ALA)

WI Procedures for Applying for Examination (Work Experience Instructor Candidate)

MAINE STATE BOARD OF NURSING

NORTH CAROLINA STATE BOARD OF DENTAL EXAMINERS

Gilmer Independent School District 500 So. Trinity Gilmer, Texas Phone: (903) FAX: (903)

Arizona Department of Education

LOS BANOS POLICE DEPARTMENT VITAL APPLICATION PACKET TH Street Los Banos, CA Telephone (209) Fax (209)

Joint Committee on Volunteer Permits EMERGENCY SERVICE VOLUNTEER WARNING LIGHT PERMIT APPLICATION PACKAGE

Volunteer Application

(e) Revocation is the invalidation of any certificate held by the educator.

Name of Student Birth Date Sex Grade. Parent/Guardian Phone Number. Address: City Zip

AMERICAN AMBULANCE SERVICE, INC.

VILLAGE OF SOUTH ELGIN APPLICATION FOR LIQUOR LICENSE FOR INDIVIDUALS AND NON-INCORPORATED ENTITIES

Washington County Tennessee Sheriff s Office. Ed Graybeal, Sheriff. Employment Application Packet

Massage Therapist License Application W 87 Street Pkwy Phone Lenexa, KS Fax

Certified Prevention Specialist (CPS) International Certification and Reciprocity Consortium (IC&RC) Reciprocal Credential

CITY OF GLENDALE APPLICATION FOR POLICE OFFICER CHECK LIST

Matlacha/Pine Island Fire Control District 5700 Pine Island Road Bokeelia, FL APPLICATION FOR EMPLOYMENT

In New York, responsible alcohol service training is voluntary. ServSafe Alcohol is an approved program in New York.

MAINE STATE BOARD OF NURSING

Beach Segment III Coastal Dune Restoration Grant Program

Annotated Mississippi Code _Title 43. Public Welfare _Chapter 20. Child Care Facilities _Mississippi Child Care Licensing Law. Miss. Code Ann.

THE GENERAL ASSEMBLY OF PENNSYLVANIA HOUSE BILL

MISSISSIPPI DEPARTMENT OF PUBLIC SAFETY SECURITY GUARD PERMIT APPLICATION

Missouri Revised Statutes

Criminal Justice Counselor

Employee Statement and Security Guard Application FEE $36

DEPARTMENT OF HUMAN SERVICES AGING AND PEOPLE WITH DISABILITIES DIVISION OREGON ADMINISTRATIVE RULES CHAPTER 411 DIVISION 58

REINSTATEMENT APPLICATION PACKET:

Application for Pre-Qualification as a Professional Consultant CCNA

Missouri Sheriffs Association Training Academy APPLICATION

CODE OF MARYLAND REGULATIONS (COMAR)

Senate Bill No. 453 Committee on Health and Human Services

CHAPTER 29 PHARMACY TECHNICIANS

Criminal Justice Selection Center

FLORIDA BOARD OF NURSING

Last Name First Name M.I. Name You Prefer. City State Zip Address. Daytime Phone Evening Phone Best Time to Call. City State If yes, where?

24 (b) "Boards" means the Board of Medicine and the Board. 27 graduated from an approved program, who is licensed to perform

Attachment B ORDINANCE NO. 14-

NO TALLAHASSEE, July 17, Mental Health/Substance Abuse

AN ACT. The General Assembly of the Commonwealth of Pennsylvania hereby enacts as follows:

Small Business Enterprise Program Participation Plan

Name of Sex: M F Applicant: Last First Middle. Date of Birth: Social Security Number: Phone: ( ) City State Zip. Phone: ( ) City State Zip

LIBERTY DENTAL PLAN. Dental Hygienist - Credentialing Application. City: State: DEGREE: City: State: DEGREE:

Application for Temporary Authorization Original OR Renewal (Instructional)

Application & Investigation Fee of $ payable to the City of Rochester must accompany this completed Application

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing.

Internship Application Student Teacher Acceptance

LEAGUE CITY VOLUNTEER FIRE DEPARTMENT 555 W. Walker League City, TX Phone

Substitute Application Instructions

Carlisle Police Department Employment Application

SPEECH-LANGUAGE PATHOLOGY ASSISTANT (SLPA) REQUIREMENTS AND INSTRUCTIONS

Agency for Health Care Administration

ENROLLMENT APPLICATION

NATIONAL MILITARY FISH AND WILDLIFE ASSOCIATION

Nursing Student Loan Forgiveness Program Application Package

Credentialing Application

Pennsylvania Certification by Endorsement

NON-TEACHING APPLICATION

Signature: Signed by GNT Date Signed: 5/8/13

REQUEST FOR STATEMENTS OF INTEREST NUMBER N R-800X PROJECT TO BE INITIATED IN FISCAL YEAR 2018

65-1,201. Definitions. As used in the residential childhood lead poisoning prevention act: History: L. 1999, ch. 99, 2; Apr. 22

CODE OF MARYLAND REGULATIONS (COMAR)

DURANGO SCHOOL DISTRICT 9-R Application for AUTHORIZED VOLUNTEER status

MASSAGE THERAPIST LICENSE APPLICATION

DIVISION 15. ENVIRONMENTAL STANDARDS FOR BEACH AND DUNE PROTECTION*

Florida Department of Environmental Protection

Texas Credit Union Department page 1 of 2 VOLUNTEER APPLICATION and AGREEMENT TO SERVE

Request for Proposal Event Services Annual Bike Race

APPLICATION FOR REINSTATEMENT OF AN EDUCATOR S LICENSE (PRINT OR TYPE ALL INFORMATION)

EMPLOYMENT PROCEDURES FOR SUBSTITUTE TEACHING STAFF

Thank you for your interest in Tropic Ocean Airways.

Direct Component Project Evaluation Form

Application for Contracted Services

MT. WASHINGTON FIRE PROTECTION DISTRICT 772 NORTH BARDSTOWN ROAD MT. WASHINGTON, KY

Transcription:

MARINE TURTLE PERMIT APPLICATION FLORIDA FISH AND WILDLIFE CONSERVATION COMMISSION DIVISION OF HABITAT AND SPECIES CONSERVATION 19100 SE Federal Highway, Tequesta, Florida 33469 Ph: 561-575-5407 Fax: 561-743-6228 Complete all information that is applicable to your permit request. If additional space is required other than what is provided on the form, you may provide additional attachments as long as they are clearly marked and identifiable. Applications will not be evaluated until all requested information and reporting documentation required by previously held permits has been submitted. (Please Print or Type) A. GENERAL APPLICANT INFORMATION Name: Date of Birth: / / Affiliation: Mailing Address: City: State: Zip: County: Fax: ( ) Phone Number: ( ) Alt. Phone Number: ( ) Email Address: This application is for a(n): New Permit Renewal Amendment To Existing Permit Previous Marine Turtle Permit Number: To provide more timely exchange of information please check this box: I authorize FWC to send me future correspondence regarding this application, including requests for additional information and final agency permitting actions by either e-mail or express delivery. Future agency actions will be provided henceforth by either e-mail or express delivery. Have you ever been convicted or found guilty of any criminal or non-criminal violation, regardless of adjudication or plea entered, of any fisheries or wildlife violation (including a violation of Chapters 379, 370, 372, F.S.; Section 597.004, F.S.; Title 5L-3.004, F.A.C.; rules of the Commission; 50 CFR Parts 622, 635, 640, 648, 654, 660, or 679; similar laws or rules in another jurisdiction)? If yes, please explain and list the type(s) of violation(s) cited and the county/state where the violation occurred: Have you ever had a fisheries or wildlife related permit suspended or revoked? If yes, please explain: Applicant Signature: Date: Certification: I hereby swear and affirm by signature that the information submitted in this application and supporting documents is complete and accurate to the best of my knowledge and belief. I understand that any false statement herein may subject me to criminal penalties. I further state that I will abide by all applicable State, Federal, and local laws. Any false statements or misrepresentations when applying for this license may result in felony charges and will result in revocation of this license. By signing this document, I also agree to comply with the reporting and notification requirements outlined in sections T and U of this application form. FWC Form 32-101 Revised 06/14 Page 1 of 5 Rule 68E-1.004

B. ELIGIBILITY. A Marine Turtle Permit may be issued only to a properly accredited individual as defined below: (1) Students of colleges or universities whose studies with saltwater animals are under the direction of their teacher or professor. (2) Scientific or technical faculty of public or private colleges or universities. (3) Scientific or technical employees of private research institutions and consulting firms. (4) Scientific or technical employees of city, county, state, or federal research or regulatory agencies. (5) Members in good standing or recognized and properly chartered conservation organizations, the Audubon Society, or the Sierra Club. (6) Persons affiliated with aquarium facilities or museums, or contracted as an agent thereof, which are open to the public with or without an admission fee. (7) Persons without specific affiliations listed above, but who are recognized by the commission for their contributions to marine conservation such as scientific or technical publications, or through a history of cooperation with the commission in conservation programs such as turtle nesting surveys, or through advanced educational programs such as high school marine science centers. Permits are issued to individuals and are not transferable. The Commission shall not issue permits to individuals unable to demonstrate a working knowledge of current marine turtle conservation practices, to individuals lacking specific experience in conducting marine turtle research or conservation activities, to individuals who do not meet the applicable criteria in 68E, F.A.C., or if there is no demonstrated need for the project. C. CONSERVATION & RESEARCH ACTIVITIES. Please list all proposed activities. If you are applying for a new permit or amending a permit to include a new activity, for each proposed activity: (1) include a detailed description of qualifications and experience of the applicant relevant to the proposed activities; (2) explain the purpose, objectives, or justification for the activity; (3) detail the methodology (complete Section H and attach research proposal if appropriate); and (4) describe the benefits to the recovery of marine turtle populations in Florida. D. NESTING SURVEY AREA. Identify the proposed nesting survey area. Include detailed area maps if this is an application for a new permit or an addition to a nesting area previously permitted. If activities are to be conducted within any state park, specify the park name(s) below. County (ies): Beach Name(s): Northern/Western Boundary: Southern/Eastern Boundary: Exclusions (within N/W-S/E boundaries): Anticipated start date: Ending date: Anticipated number of survey days/week Has FWC authorized you to conduct nesting surveys in this area in previous years? E. BEACH MONITORING PROJECTS. Please list each beach monitoring project (e.g., nourishment, renourishment, sand placement, dune reconstruction), including project name and DEP permit number, requested for authorization under this permit. Please note that all new beach monitoring requests must be reviewed and approved by FWC. TITLE(S): FWC Form 32-101 Revised 06/14 Page 2 of 5 Rule 68E-1.004

F. MECHANICAL BEACH CLEANING ACTIVITIES. Identify any areas within your survey area where mechanical beach cleaning takes place between March 1 and October 31. County Beach name (as it appears on your permit) and boundaries of beach cleaning activities Name of Beach Cleaning Company Contracted for Beach Cleaning Monitoring? G. RESEARCH PROJECTS. Please list each research project requested for authorization under this permit. Please note that all new research requests must be accompanied by a detailed proposal (see FWC Sea Turtle Conservation Guidelines for appropriate proposal format). Include detailed area maps of project area if applicable. TITLE(S): H. OTHER AGENCY PERMITS. Identify all permits required from other state or federal agencies for the proposed project(s). Indicate date the permit was acquired or application was submitted, and submit copies of those permits or applications in conjunction with this application form. I. REPORTING REQUIREMENTS. Various conservation, research and monitoring activities require submission of an annual report detailing the activities conducted in association with the permitted activity. Permits will not be processed until all applicable reports are received. Check all appropriate boxes below. Nesting Survey Reports Tagging Program Research Project Turtle Walk Summary Monitoring Project Hatchling Release Summary Quarterly Holding Facility Reports Trawl/Capture J. PERMIT COPIES. Please be aware that all authorized personnel must have the original permit or a copy of the permit signed by both FWC and the Permit Holder (applicant) in his/her possession while conducting permitted authorized activities. K. APPLICATION SUBMISSION. Applications may be submitted electronically to the Marine Turtle Permit Coordinator (email to MTP@MyFWC.com), may be faxed to (561) 743-6228, or may be mailed to the following address: FWC Marine Turtle Permits 19100 SE Federal Highway Tequesta, FL 33469 Documents submitted separately from an application form must be marked (or files named) with the applicant s name and affiliation. FWC Form 32-101 Revised 06/14 Page 3 of 5 Rule 68E-1.004

L. AUTHORIZED PERSONNEL. A Permit Holder may request that additional personnel be included on a permit. The Commission shall allow up to twenty-four (24) volunteers to conduct marine turtle conservation work under the supervision of the permit holder if requested. Please list below: (1) the full legal first name; (2) last name; (3) complete mailing address; and (4) telephone number for each individual. Please note that the Permit Holder is responsible for all activities conducted by persons authorized on the permit. NAME CONTACT INFORMATION First Last Mailing Address Phone Number FWC Form 32-101 Revised 06/14 Page 4 of 5 Rule 68E-1.004

FWC Form 32-101 Revised 06/14 Page 5 of 5 Rule 68E-1.004