/ Sonoma State University
FIELD STATIONS & NATURE PRESERVES
General Use Application
(for visits that are not university-level education or research)
For questions with regards to this application, please call (707) 795-5069
Check the Preserve(s) you wish to visit
Fairfield Osborn Preserve Galbreath Wildlands Preserve
1. APPLICANT INFORMATIONAPPLICANT:
AFFILIATION: Sonoma State University Other (Name)
CELL PHONE: OTHER PHONE: FAX:
IN CASE OF EMERGENCY: Contact: Emergency Phone:
2. GROUP INFORMATION
Group/Class Name (if applicable):
Group Type: Elementary School Middle School
Conference/Meeting Other (please describe your group)
Number of participants
3. PROPOSED DATESDay 1 / Day 2 / Day 3 / Day 4 / Day 5
4. TRANSPORTATION - Parking is limited. Please carpool if possible.
Number of Vehicles:
Type of vehicles: Van 4-wheel drive Bus Passenger Vehicle
4. FACILITY NEEDS: NONE – Trail Use Only
GALBREATH PRESERVE: White Oak Campsite Rancheria Creek Campsite
OSBORN PRESERVE: CONFERENCE ROOM (Marjory Osborn Education & Research Center)
Begin Time: End Time:
laptop w/ projector slide projector overhead projector
6. PROPOSED ACTIVITIES
Will you or your group:
Handle or remove organisms or artifacts from the Preserve? Yes No
If yes, please specify:
Cultural Artifacts (An artifact is any object that is made, modified or deposited by humans, such as rock flakes, potsherds, fences, and stone rings.)
Plants Invertebrates Vertebrates Other
Endangered or threatened species
Transfer animals, plants, microorganisms or soil from outside the Preserve to within the Preserve, or between areas of the Preserve? Yes No
Use isotopes or chemicals? Yes No If yes, list substances used:
Disturb soil? Include even minor activities such as use of shovels or trowels. Yes No
Describe your proposed activities. Be sure to include descriptions of any activities referenced in the above questions.
- FIELD STATION & NATURE PRESERVE REGULATIONS
Preserve rules and regulations are designed to ensure protection of natural and cultural resources, research and educational activities, and the safety of visitors and staff. By signing this form, the Applicant:
- Acknowledges that he/she has read and agrees to abide by the regulations identified in:
- Accepts responsibility for all persons working under this permit to understand and comply with Preserve rules and regulations
- Understands that:
- disturbance or removal of organisms, soil, rocks, artifacts, flags, posts or other markers is not allowed without an approved application that describes the proposed activity.
- pre-historic or historic artifacts found in the Preserve should be reported to Preserve staff but not moved.
- Agrees to notify the SSU Field Stations & Nature Preserves before each visit.
- Agrees to remove all materials related to your activities upon the completion of your project (unless written approval is granted).
- Agrees to acknowledge Sonoma State University Field Stations & Nature Preserves in publications resulting from use of the Preserves, and submitting a copy of all publications to the Preserve Director.
I have read this application and all supporting documents. I swear that to the best of my ability I have provided accurate information in filling out this application. I understand that I can lose my visiting privileges if I do not abide by the conditions stipulated in this application.
Preserve Director’s ApprovalDate
* Receipt of application via email is comparable to applicant’s signature.
Before submitting, please save this form as lastname.month+day+year.doc (e.g., smith.121510.doc)
Submit completed application via email to:
Mailing Address: 6543 Lichau Road, Penngrove, CA, 94951
Phone: (707) 795-5069, Fax: (707) 664-3012