Appendix no. 1 to Ordinance no. 9/2017
of the Director of the Biebrza National Park of28th February 2017
on thepermissions for research, teaching
and monitoring in the Biebrza National Park
stamp of applicant
APPLICATION FOR RESEARCH PERMIT IN THE BIEBRZA NATIONAL PARK
1.Applicant: ..………….………………..………………………………………………………………
2.Adress: ………..………………………………………………………………………….…………...
3.Contact person (first name, last name, address, e-mail, phone number): ……...………………………………
4.Topic: …………….……………………………………………………..……………………………..
5. Aims and expected results:…………....…………………………………………………………...
5a. Planned duration of the field works (specify the period, e.g. 2017-2020):
………………………………………………………………………………………………......
5b. First application/continuation of research (underline appropriate)
6.Type of work(bachelor's degree, engineering work, MSc, PhD, postdoctoral, statutory research, inventory, science camp, underline appropriate,if other, please, specify):
…...….……………………………………………………………………………………………….
7.Location (indicate detailed locations of the field studies in the Biebrza National Park on topographic map on an appropriate scale to show the scope of work, and as digital vector objects in coordinate system PUWG 1992 - points, lines, polylines or polygons - that should be transferred by electronic media - CD, DVD, Blu-ray, USB flesh drive, etc., attached to the application):
.……………………………………………………………………………………………………....
8.Methods (describe in detail the methods of study, observations, their frequency and planned dates, if collectionof natural materials is necessary, specify type and quantity):
……………………………………………………………………………………………………….
8a. Marking of study sites or plots(if marking will be used,describe means and dates of markingand its removal,if not please write “no applicable” or “N/A”):
……………………………………………………………………………………………………….
9. Participants (names of persons who will participate in the field studies and their affiliations. In the case of scientific camp, please indicate the person responsible for running of the camp - first name, surname, e-mail, mobile phone number, the address where he/she will be present during the camp and provide the list of all participants):
…………………………………………………………………………………………………….…
9a.The participants will work in BbNP: separately/in group (underline appropriate)
10. Vehicles (if the vehicle/vehicleswillbe used within the area of BbNP beyond public roads, please include car makes and registration numbers of all vehicles):
……………………………………………………………………………………………………….
10a. There is need to drive vehicles along the roads closed by boom barriers: yes/no (underline appropriate). If "yes"- please specify precinct/circuit:
….…………………………………………………………………………………………………....
10b. Thevehicle/vehicles will be used: separately/in group by participants (underline appropriate)
11. Duration of the field works (start and end data): from………………… to…………………
12. I confirm that I know and accept the Ordinance no. 9/2017 of the Director of the Biebrza National Park of 28th February 2017 on the permissions for research, teaching and monitoring in the Biebrza National Park.
Place, date, personal stamps andsignatures…………………………………………………………
(according to §2, section 8 of the Ordinance no. 9/2017 of the Director of the Biebrza National Park of28th February 2017 on the permissionsfor research, teaching and monitoring in the Biebrza National Park)
According to art. 23, section 1, point 1 of the Act of 29 August 1997 on the protection of personal data (Dz.U. z 2016 r., poz. 922), I consent to the processing of my personal data for purposes of research and publication of research topics on the website of the Biebrza National Park.
I acknowledge that the administrator of my personal data is the Biebrza National Park located in Osowiec-Twierdza 8, 19-110 Goniądz; personal data will be processed for purposes of research and publication of research topics on the website of Biebrza NP; I have the right to access to my data and to correct them; providing personal data is voluntary.
………………………………………………………….
legible signature of the applicant (for physical person), personal stamp