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!