8100-FM-FR0034 Rev. 1/11
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF CONSERVATION AND NATURAL RESOURCES
BUREAU OF FORESTRY
WILD PLANT MANAGEMENT PERMIT APPLICATION
I hereby apply for a Pennsylvania Wild Plant Management Permit to remove, collect or transplant wild plants
classified as PA Endangered or PA Threatened as listed within 17 Pa. Code Chapter 45, “The Conservation of
Pennsylvania Native Wild Plants.” Enclosed is a check for $5.00, payable to the “Commonwealth of PA.” for the
Wild Plant Management Permit.
NAME OF APPLICANT ____________________________________________________________
COMPANY (IF APPLICABLE)________________________________________________________
ADDRESS _________________________________________________ PHONE _______________________
E MAIL____________________________________________
PREVIOUS WILD PLANT MANAGEMENT PERMIT NUMBERS_______________________________________________
HAVE YOU EVER HAD A WILD PLANT MANAGEMENT PERMIT REVOKED? IF YES, LIST PERMIT NUMBER(S) AND
EXPLAIN______________________________________________________________________________________
WHAT IS THE PURPOSE OF YOUR APPLICATION FOR A WILD PLANT MANAGEMENT PERMIT? (CHECK ONE)
□
CONDUCTING BOTANICAL SURVEYS FOR SOSC (PLEASE COMPLETE PAGES 3 THROUGH 6)
□
SCIENTIFIC RESEARCH (PLEASE COMPLETE PAGE 7)
□
MITIGATION MEASURES IN RESPONSE PNDI REVIEW (PLEASE COMPLETE PAGES 8 AND 9)
□
OTHER (PLEASE EXPLAIN)_____________________________________________________
MAY WE ADD YOUR NAME ON THE WILD PLANT MANAGEMENT WEBSITE AS SOMEONE WHO COULD BE CONTACTED TO
CONDUCT A PLANT SURVEY?
YES___________ NO_____________
**THIS APPLIES TO FUTURE LISTS DEVELOPED BY DCNR, NOT TO LISTS MAINTAINED BY CARNEGIE MUSEUM.
IF VOUCHER SPECIMENS ARE NECESSARY TO AID IN FURTHER IDENTIFICATION OF SPECIES FOUND ON SITE OR TO
DOCUMENT A NEWLY DISCOVERED POPULATION, THE APPLICANT AGREES TO FOLLOW THE VOUCHER SPECIMEN
COLLECTION PROCEDURES SET FORTH BY DCNR.
INITIAL HERE_________
THE APPLICANT UNDERSTANDS THAT ANY LOCATION AND HABITAT INFORMATION REGARDING ANY PA PLANT
SPECIES OF SPECIAL CONCERN (SOSC) FOUND ON SITE (WHETHER DCNR SURVEY REQUEST TARGET SPECIES OR NOT)
MUST BE REPORTED TO DCNR AND/OR THE PA NATURAL HERITAGE PROGRAM. A LIST OF ALL PA PLANT SPECIES
OF CONCERN CAN BE FOUND AT http://www.naturalheritage.state.pa.us/PlantsPage.aspx
INITIAL HERE__________
ALL APPLICATION INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE, INFORMATION, AND BELIEF.
SIGNATURE OF APPLICANT____________________________________________DATE______________________
PLEASE CAREFULLY REVIEW THE FOLLOWING PAGES AND SUBMIT ALL APPLICABLE INFORMATION, ALONG WITH THE
COVER SHEET TO:
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8100-FM-FR0034 Rev. 1/11
DCNR BUREAU OF FORESTRY
ECOLOGICAL SERVICES SECTION
400 MARKET STREET
PO BOX 8552
HARRISBURG, PA 17105-8552
DISCLAIMER: THIS WILD PLANT MANAGEMENT PERMIT IS NON-TRANSFERABLE. PERMIT HOLDERS ARE REQUIRED
TO BE IN THE FIELD DURING ALL BOTANICAL SURVEYS FOR PA P LANT SPECIES OF SPECIAL CONCERN. PERMITS WILL
BE GRANTED TO INDIVIDUALS ONLY AND WILL NOT BE GRANTED TO COMPANIES OR ORGANIZATIONS. ANY APPLICANT
WHO IS DENIED A WILD PLANT MANAGEMENT PERMIT RESERVES THE RIGHT TO APPEAL THIS DECISION. DCNR MAY
REVOKE A WILD PLANT PERMIT FOR A GOOD CAUSE, INCLUDING BUT NOT LIMITED TO FAILURE TO COMPLY WITH A
TERM OR CONDITION OF THEIR PERMIT, OR CHANGES IN THE CIRCUMSTANCES DESCRIBED IN THE APPLICATION FOR THE
PERMIT, WHICH INDICATE THAT THE ACTIVITY NO LONGER IS IN THE BEST INTERESTS OF PENNSYLVANIA WILD PLANT
MANAGEMENT. A PERSON WHOSE PERMIT HAS BEEN REVOKED IS NOT ELIGIBLE TO APPLY FOR OR OBTAIN ANOTHER
WILD PLANT MANAGEMENT PERMIT FOR 2 YEARS FROM THE DATE OF REVOCATION. WILD PLANT MANAGEMENT
REGULATIONS CAN BE VIEWED AT : http://www.pacode.com/secure/data/017/chapter45/chap45toc.html
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8100-FM-FR0034 Rev. 1/11
WILD PLANT MANAGEMENT PERMIT APPLICATION
QUALIFIED SURVEYOR ADDENDUM
If applying for a Wild Plant Management Permit in order to conduct botanical surveys in response to a PNDI review
or scientific research, please complete pages 3 through 6 of this form and return this “Qualified Surveyor
Addendum” with the Application Cover Page.
The information collected from these questions will be used both to evaluate the qualifications of the applicant and
to compile a list of botanists with various specialized areas of expertise who are potentially available to conduct
botanical surveys (related to PNDI Environmental Review or scientific research) in Pennsylvania.
HAVE YOU REVIEWED THE DCNR “PROTOCOLS FOR CONDUCTING SURVEYS FOR PLANT SPECIES OF SPECIAL
CONCERN,” AND ARE YOU WILLING TO FOLLOW THESE PROTOCOLS FOR ALL BOTANICAL SURVEYS FOR PA
PLANT SPECIES OF SPECIAL CONCERN?
YES___________ NO_____________
PLEASE NOTE- THE PROTOCOLS HAVE BEEN REVISED AS OF JANUARY 2011.
THESE PROTOCOLS ARE AVAILABLE AT: http://www.gis.dcnr.state.pa.us/hgis-er/PNDI_DCNR.aspx
THE APPLICANT UNDERSTANDS THAT DCNR OR PA NATURAL HERITAGE PROGRAM PERSONNEL MAY NEED
TO VISIT A PROJECT SITE IF NECESSARY TO AID IN ANY FURTHER ENVIRONMENTAL REVIEW FOR A
PARTICULAR PROJECT PRIOR TO OR FOLLOWING A REQUIRED BOTANICAL SURVEY OR HABITAT ASSESSMENT.
INITIAL HERE____________
EDUCATIONAL BACKGROUND (PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY)
PLEASE EXPLAIN YOUR EDUCATIONAL BACKGROUND (I.E. DEGREES EARNED, UNDERGRADUATE AND/OR
GRADUATE COURSEWORK PERTAINING TO ECOLOGY, BOTANY, PLANT TAXONOMY, ECOSYSTEM
CLASSIFICATION, FORESTRY, ETC.)
LIST ANY WORKSHOPS OR TRAINING PROGRAMS YOU HAVE ATTENDED RELATED TO PLANT IDENTIFICATION,
PLANT TAXONOMY, FORESTRY, ECOSYSTEM CLASSIFICATION OR WETLAND DELINEATION.
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8100-FM-FR0034 Rev. 1/11
BOTANICAL EXPERIENCE (PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY)
HOW LONG HAVE YOU BEEN CONDUCTING BOTANICAL FIELD SURVEYS (PLEASE REPORT IN HOURS AND
YEARS)? IN WHAT CONTEXT HAVE THESE SURVEYS BEEN CARRIED OUT (WETLAND DELINEATION,
COMMUNITY CLASSIFICATION, RESEARCH, PNDI PLANT SURVEYS, ETC)? WHAT PORTION OF THIS
EXPERIENCE HAS BEEN WITHIN PENNSYLVANIA?
PLEASE LIST RECENT SURVEYS THAT YOU CONDUCTED (IN RESPONSE TO A BOTANICAL SURVEY REQUEST BY
DCNR OR OTHERWISE) DURING WHICH SOSC WERE FOUND (ATTACH ADDITIONAL SHEETS IF NECESSARY).
PLEASE INCLUDE THE DATE, COUNTY, SPECIES, AND PNDI NUMBER (IF APPLICABLE).
IF YOU HAVE FOUND SOSC DURING MORE THAN TEN SURVEYS, YOU NEED NOT LIST MORE THAN TEN. IF YOU
HAVE FOUND SOSC FEWER THAN TEN TIMES, PLEASE INCLUDE SURVEYS FOR WHICH SOSC WERE TARGETED
BUT NOT FOUND, TO REACH A MAXIMUM OF TEN SURVEYS. IF YOU HAVE NOT YET CONDUCTED TEN SURVEYS,
PLEASE INCLUDE INFORMATION FOR AS MANY SURVEYS AS POSSIBLE. DCNR WILL BE USING THIS
INFORMATION IN EFFORTS TO ACCUMULATE A LIST OF BOTANICAL EXPERTS BY SPECIES. IF YOU HAVE EXPERIENCE
WITH A LARGE NUMBER OF SPECIES, IT MAY BE USEFUL TO REPRESENT THAT DIVERSITY, RATHER THAN JUST THE
MOST RECENT TEN SURVEYS.
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8100-FM-FR0034 Rev. 1/11
BOTANICAL EXPERIENCE (CONT.) (PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY)
ARE THERE ANY PARTICULAR RARE SPECIES, TAXONOMIC GROUPS, GEOGRAPHICAL REGIONS, ECOREGIONS
(I.E, RIDGE AND VALLEY, ALLEGHENY PLATEAU, ETC), OR ECOSYSTEMS (WETLANDS, INTERTIDAL ZONES,
RECLAIMED MINING AREAS, AQUATIC HABITATS, ETC.) WITHIN PENNSYLVANIA IN WHICH YOU ARE
PARTICULARLY EXPERIENCED OR QUALIFIED? PLEASE EXPLAIN YOUR EXPERIENCE. PLEASE NOTE – THIS
INFORMATION WILL BE NOT BE USED TO QUALIFY OR DISQUALIFY ANY APPLICANTS, BUT IS FOR INTERNAL
PURPOSES TO DETERMINE WHERE SOSC EXPERTISE EXISTS WITHIN PENNSYLVANIA.
PLEASE PROVIDE NAMES AND CONTACT INFORMATION OF THREE PEOPLE WHOM CAN ATTEST TO YOUR
BOTANICAL SKILLS AND FIELD EXPERIENCE WITH THE FLORA OF PENNSYLVANIA. INCLUDE AT LEAST TWO
REFERENCES WHOM HAVE SPENT TIME WITH YOU IN THE FIELD AND CAN VERIFY YOUR FIELD IDENTIFICATION
SKILLS.
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8100-FM-FR0034 Rev. 1/11
PROTOCOLS AND COLLECTIONS (PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY)
HAVE YOU SUBMITTED VOUCHER SPECIMENS TO HERBARIA IN PENNSYLVANIA IN THE PAST? IF SO, WHICH
HERBARIA (CARNEGIE MUSEUM, MORRIS ARBORETUM, SHIPPENSBURG UNIVERSITY, PENN STATE
UNIVERSITY, CLEVELAND MUSEUM OF NATURAL HISTORY, WESTERN PA CONSERVANCY, ETC.)? IF
POSSIBLE, PLEASE LIST UP TO THE 5 MOST RECENT VOUCHER SPECIMEN REFERENCES.
PLEASE EXPLAIN YOUR APPROACH IN PREPARING FOR A SURVEY. INCLUDE ANY REFERENCES OR MATERIALS
USED. DOES THIS APPROACH CHANGE BASED ON SPECIES? DOES THIS APPROACH CHANGE FOR SPECIES YOU
ARE FAMILIAR VS. UNFAMILIAR WITH?
DCNR ENCOURAGES A REASONABLY COMPLETE LIST OF ALL PLANT SPECIES FOUND ON SITE TO BE REPORTED
WHEN CONDUCTING BOTANICAL SURVEYS. ALL SPECIES LISTED ARE TO BE IDENTIFIED TO SPECIES LEVEL.
WHAT IS YOUR STANDARD APPROACH WHEN YOU ARE UNABLE TO IDENTIFY A SPECIMEN? LIST ANY
BOTANICAL CONTACTS WITH WHOM YOU REGULARLY CONSULT WITH TO AID IN IDENTIFICATION OF THESE
TROUBLE GENERA.
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8100-FM-FR0034 Rev. 1/11
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF CONSERVATION AND NATURAL RESOURCES
BUREAU OF FORESTRY
WILD PLANT MANAGEMENT PERMIT APPLICATION
RESEARCH ADDENDUM
If applying for a Wild Plant Management Permit in order to conduct scientific research concerning PA Plant Species
of Special Concern (SOSC), please complete this page and return this “Research Addendum” with the Application
Cover Page (please attach additional pages to this addendum if necessary). Current Permit Holders are not required
to pay another $5 fee.
PLEASE LIST THE SCIENTIFIC NAME OF THE PLANT SPECIES (OR HABITAT TYPES) TO BE STUDIED:
PLEASE PROVIDE A DESCRIPTION OF THE PROPOSED RESEARCH PROJECT:
PLEASE PROVIDE ANY APPLICABLE BACKGROUND INFORMATION REGARDING THE APPLICANT’S KNOWLEDGE,
EXPERIENCE AND CREDENTIALS AS IT RELATES TO A PA PLANT SPECIES OF SPECIAL CONCERN THAT ARE PROPOSED
TO BE STUDIED:
PLEASE NOTE: VERBAL CONSENT OF THE LANDOWNER(S) MUST BE OBTAINED PRIOR TO CONDUCTING
PERMITTED ACTIVITIES.
LANDOWNER NAME(S):
ADDRESS:
TELEPHONE NUMBER:
EMAIL (OPTIONAL):
*PLEASE PROVIDE THE LOCATION(S) OF THE PROPOSED ACTIVITY (INCLUDE AN OUTLINE OF THE AFFECTED AREAS
DRAWN ON A USGS MAP OR COPY (GIS SHAPEFILES WILL ALSO BE ACCEPTED)*
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8100-FM-FR0034 Rev. 1/11
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF CONSERVATION AND NATURAL RESOURCES
BUREAU OF FORESTRY
WILD PLANT MANAGEMENT PERMIT APPLICATION
MITIGATION MEASURES ADDENDUM
If applying for a Wild Plant Management Permit in order to carry out mitigation measures required by DCNR in
response to a PNDI review and anticipated conflict concerning PA Plant Species of Special Concern (SOSC), please
complete this page and page 9 and return this “Mitigation Measures Addendum” with the Application Cover Page
(please attach additional pages to this addendum if necessary). Current Permit Holders are not required to pay
another $5 fee.
*PLEASE PROVIDE THE LOCATION(S) OF THE PROPOSED ACTIVITY (INCLUDE AN OUTLINE OF THE AFFECTED AREAS
DRAWN ON A USGS MAP OR COPY (GIS SHAPEFILES WILL ALSO BE ACCEPTED)*
PLEASE PROVIDE A DESCRIPTION OF THE PROPOSED PROJECT (PLEASE LIST THE PNDI NUMBER AND ATTACH ANY
DCNR RESPONSE LETTERS).
PLEASE LIST THE SCIENTIFIC NAME OF THE PLANT SPECIES TO BE AFFECTED.
PLEASE LIST THE CONTACT INFORMATION OF WHOM WILL BE CARRYING OUT THE ACTIVITY.
NAME:
WILD PLANT PERMIT NUMBER (IF APPLICABLE):
COMPANY (IF APPLICABLE):
ADDRESS:
PHONE NUMBER:
EMAIL (OPTIONAL):
PLEASE NOTE: VERBAL CONSENT OF THE LANDOWNER(S) MUST BE OBTAINED PRIOR TO CONDUCTING
PERMITTED ACTIVITIES.
LANDOWNER NAME(S):
ADDRESS:
TELEPHONE NUMBER:
EMAIL (OPTIONAL):
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8100-FM-FR0034 Rev. 1/11
WILD PLANT MANAGEMENT PERMIT APPLICATION
MITIGATION MEASURES ADDENDUM (Cont.)
PLEASE EXPLAIN IN DETAIL THE PROPOSED MITIGATION ACTIVITY (PLEASE BE AS SPECIFIC AS POSSIBLE).
PLEASE PROVIDE ANY APPLICABLE BACKGROUND INFORMATION REGARDING THE KNOWLEDGE, EXPERIENCE AND
CREDENTIALS OF THE PERSON OR PERSONS CARRYING OUT THE PROPOSED ACTIVITY AS IT RELATES TO THE PA PLANT
SPECIES OF SPECIAL CONCERN THAT ARE TO BE AFFECTED.
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8100-FM-FR0034 Rev. 1/11
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF CONSERVATION AND NATURAL RESOURCES
BUREAU OF FORESTRY
WILD PLANT MANAGEMENT PERMIT APPLICATION
ANNUAL RENEWAL FORM
NAME___________________________________
PREVIOUS PERMIT NO.________________________
* PLEASE SUBMIT THE WILD PLANT MANAGEMENT PERMIT APPLICATION COVER PAGE ALONG WITH THIS ANNUAL
RENEWAL FORM TO HELP EXPEDITE THE RENEWAL OF YOUR WILD PLANT MANAGEMENT PERMIT. PLEASE ATTACH
ADDITIONAL SHEETS IF NECESSARY.
PLEASE INDICATE WORKSHOPS, TRAINING PROGRAMS OR FIELD WORK (PNDI SURVEYS CAN BE LISTED BELOW) THAT
YOU HAVE COMPLETED IN THE PAST YEAR THAT STRENGTHENS YOUR QUALIFICATIONS AND/OR KNOWLEDGE
REGARDING OF PA PLANT SPECIES OF SPECIAL CONCERN (SOSC).
HAVE THE NAMES OR CONTACT INFORMATION OF THREE PEOPLE WHOM CAN ATTEST TO YOUR BOTANICAL SKILLS AND
EXPERIENCE WITH THE FLORA OF PENNSYLVANIA CHANGED SINCE YOUR LAST APPLICATION WAS REVIEWED?
PLEASE LIST ALL SURVEYS THAT WERE CONDUCTED IN RESPONSE TO A BOTANICAL SURVEY REQUEST BY DCNR (OR
RESEARCH CONDUCTED) TO EVALUATE IMPACTS TO PA PLANT SPECIES OF SPECIAL CONCERN SINCE YOUR LAST
PERMIT APPLICATION WAS REVIEWED (ATTACH ADDITIONAL SHEETS IF NECESSARY). PLEASE INCLUDE THE DATE,
COUNTY, SPECIES, PNDI NUMBER(S) AND OUTCOME OF THE SURVEY (SPECIES FOUND, UNSUCCESSFUL SURVEY, ETC).
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8100-FM-FR0034 Rev. 1/11
PLEASE NOTE ANY AVOIDANCE OR CONSERVATION MEASURES THAT WERE SUGGESTED AND/OR IMPLEMENTED. WAS
MONITORING REQUIRED FOR ANY PROJECTS (PLEASE LIST APPLICABLE PNDI NUMBERS)?
PLEASE NOTE ANY VOUCHER SPECIMENS THAT HAVE BEEN SUBMITTED IN THE PAST YEAR AND TO WHICH HERBARIA
THEY WERE SUBMITTED.
DISCLAIMER: THIS WILD PLANT MANAGEMENT PERMIT IS NON-TRANSFERABLE. PERMIT HOLDERS ARE REQUIRED
TO BE IN THE FIELD DURING ALL BOTANICAL SURVEYS FOR PA P LANT SPECIES OF SPECIAL CONCERN. PERMITS WILL
BE GRANTED TO INDIVIDUALS ONLY AND WILL NOT BE GRANTED TO COMPANIES OR ORGANIZATIONS. ANY APPLICANT
WHO IS DENIED A WILD PLANT MANAGEMENT PERMIT RESERVES THE RIGHT TO APPEAL THIS DECISION. DCNR MAY
REVOKE A WILD PLANT PERMIT FOR A GOOD CAUSE, INCLUDING BUT NOT LIMITED TO FAILURE TO COMPLY WITH A
TERM OR CONDITION OF THEIR PERMIT, OR CHANGES IN THE CIRCUMSTANCES DESCRIBED IN THE APPLICATION FOR THE
PERMIT, WHICH INDICATE THAT THE ACTIVITY NO LONGER IS IN THE BEST INTERESTS OF PENNSYLVANIA WILD PLANT
MANAGEMENT. A PERSON WHOSE PERMIT HAS BEEN REVOKED IS NOT ELIGIBLE TO APPLY FOR OR OBTAIN ANOTHER
WILD PLANT MANAGEMENT PERMIT FOR 2 YEARS FROM THE DATE OF REVOCATION. WILD PLANT MANAGEMENT
REGULATIONS CAN BE VIEWED AT : http://www.pacode.com/secure/data/017/chapter45/chap45toc.html
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