1. Requester:
Name:
Affiliation:
Address:
Address Line 2:
City:
State:
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NV
NW
NY
OH
OK
ON
OR
PA
PE
PR
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YU
Zip:
Phone:
Email:
2. Select Project Type:
Update label based on attached information
 
(you will be allowed to upload files on the next page)
Conduct efficacy studies to add new disease, insect, or weed to the label
Conduct crop safety studies to add new crop to the label
Conduct plant growth regulator efficacy studies
3. Environmental (Ornamental) Horticulture Crop(s):
Plant Group:
Aquatic Plant
Broadleaf Evergreen Tree/Shrub
Broadleaf Evergreen/Deciduous Tree/Shrub
Bulbs & Corms
Cactus & Succulents
Deciduous Tree/Shrub/Vine
Edibles
Fern
Hardy Ground Cover Foliage
Herbaceous Flowering Plant
Herbaceous Flowering Plant - Annual
Herbaceous Flowering Plant - Annual/Biennial/Peren
Herbaceous Flowering Plant - Perennial
Herbaceous Perennials
Narrowleaf Evergreen Tree/Shrub
Native or Naturalized Annuals
Ornamental Grass
Palm
Tropical Foliage Plant
Turf
Unknown
Common Name:
Scientific Name:
Plant Stage during Applications:
Use Site:
(i.e. greenhouse, nursery field, nursery container, interiorscape, etc.)
4. Product:
Trade Name:
Active Ingredient:
Rate Per Application:
(i.e. oz/100 gal, oz/acre)
Volume Per Application:
(i.e. gal/acre, pt/sq ft)
Number of Applications:
Application Interval:
5. Research Target/Registration Objective:
Phytotoxicity on crop(s) listed above
Efficacy on this disease, insect, or weed:
 
 
(Crop Safety information is also collected during these studies)
Plant Growth Regulator effects on crops listed above
6. Economic Impact:
Please estimate the economic impact in your state if the management tool described above is not available:
7. Labelled Products For This Use:
8. Additional Comments Or Explanation Of Need:
IMPORTANT: The more information we receive on these forms, the better we can address your needs!