1. Requester:
Name:
 
Affiliation:
 
Address:
 
Address Line 2:
City:  
State:  
Zip:  
Phone:  
Email:    
2. Select Project Type:
     
            (you will be allowed to upload files on the next page)
     
     
     

3. Environmental (Ornamental) Horticulture Crop(s):
Plant Group:  
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:
     
     
            
             (Crop Safety information is also collected during these studies)
     

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!