Request for Authorization to Access - Sampling for Scientific Purposes

Request for Authorization to Access / Sampling for Scientific Purposes

Fill out the following form to request authorization for access to the natural resources of the Azores and collection of samples for scientific purposes.

For your convenience, here you can find below links to the relevant laws in this field:

Decreto Legislativo Regional N.º 9/2012/A de 20 de Março
Establishes the legal regime on access and use of natural resources in the Azores for scientific purposes.
Decreto Regulamentar Regional N.º 20/2012/A de 5 de Novembro
Develops and regulates the legal regime on access and use of natural resources in the Azores for scientific purposes.

Applicant

Full name*

Prefix

First Name

Middle Name

Last Name

Organization / University / company / other*

Title / Function*

Experience / Professional Activity*

Idenfication*

Idenfication number*

Nationality*

Address*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Email*

Mobile / Phone*

Fax

Will the samples be collected by the applicant?*

Yes No (please identify, below, who will be collecting the samples)

Sample collector

Full name*

Prefix

First Name

Middle Name

Last Name

Organization / University / company / other*

Title / Function*

Experience / Professional Activity*

Idenfication*

Idenfication number*

Nationality*

Address*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Email*

Mobile / Phone*

Fax

Will the applicant be responsible for the scientific usage of the samples?*

Yes No (please identify below who will be)

Scientific user

Full name*

Prefix

First Name

Middle Name

Last Name

Organization / University / company / other*

Title / Function*

Experience / Professional Activity*

Idenfication*

Idenfication number*

Nationality*

Address*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Email*

Mobile / Phone*

Fax

Indication of request

Identify, in clear and precise terms, the type of natural resource to be sampled*

Detailed description of the research project

Title of project *

Indication of the R&D project that justifies the need to acess the natural resource

Start Date *

End date *

The applicant participates in the research project as:*

Main scientific coordinator

Other:

The project is oriented with the collaboration of:*

Scientific organization University Companies

Other:

Are the details of this project confidential?

Yes No

Detailed description*

(Describe the project, identifying its objectives and justification of the need to access the natural resource)

Identify other members who make up the team's research project*

Member 1 identification*