ARIZONA GAME & FISH DEPARTMENT
Terrestrial Wildlife Branch – Scientific Collecting Licenses
5000 West Carefree Hwy, Phoenix, Arizona 85086
SCIENTIFIC COLLECTING LICENSE PROPOSAL FORM 18B (NO FEE)
Name:
Affiliation/Title:
The review process is a minimum of 30 days from the time a complete application form 18A, proposal form 18B,
year-end report form 18C (if applicable), a Hazard Analysis Critical Control Point Plan - HACCP (if applicable), and
captivity standards information (if applicable) have been received, as provided in R12-4-106. If approved, the
applicant will be issued a scientific collecting license with stipulations on the activities authorized. The applicant
must receive a valid license with stipulations prior to conducting activities.
Project # ___ of ____ Title:
NOTE: Please separate project requests by taxon, where appropriate.
Purpose
(Check all that apply):
☐Wildlife management ☐ Advancement of science
☐ The promotion of the public health or welfare
☐Gathering information valuable to the maintenance of wild populations ☐Education
For education purposes explain the nature of the educational project, the venues to which you will make
presentations, and if applicable, the # of specimens of the species requested that you already possess.
Provide specific details of your project.
Qualifications
Provide details of experience related to the proposed project.
Requested Wildlife (add rows as needed); List Taxon if not targeting a single species.
Scientific Name
(at appropriate taxonomic level)
Common Name
Maximum Number
Requested
Mark the
box for
collection
☐
☐
☐
☐
☐
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ARIZONA GAME & FISH DEPARTMENT
Terrestrial Wildlife Branch – Scientific Collecting Licenses
5000 West Carefree Hwy, Phoenix, Arizona 85086
Methods
Provide details of capture methods, tools or traps used, auxiliary marking (e.g., banding, toe-clip, PIT tag, etc.).
Locality (add rows as needed)
County
Details on locality
Disposition
Provide details of disposition (e.g., salvage, non-handling, capture & release, take alive & keep alive, collect by
killing, take alive & kill later, return to laboratory, etc.).
Captivity (if applicable)
Provide the name, address and telephone # of the facilities where live wildlife will be held (if different than that listed on
form 18a) as well as a detailed description or diagram of the facilities and a description of how the facilities comply with
Live Wildlife Rule R12-4-428.
Schedule
Provide approximate time frame of the project. If this is a fish sampling project, a schedule with tentative dates must
be provided.
HACCP Plan Attached? (if applicable)
Yes ☐
No ☐
Publication intent
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ARIZONA GAME & FISH DEPARTMENT
Terrestrial Wildlife Branch – Scientific Collecting Licenses
5000 West Carefree Hwy, Phoenix, Arizona 85086
Agents (add rows as needed)
An agent is any person that will be assisting with the project and will be conducting activities with or without the
license holder present.
Agent’s Full Name
Agent’s Address
ADDITIONAL INFORMATION:
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