DATE: _____________________
 

County Extension Agent (or other specialist sending specimens) Name_____________________________________ Address___________________________________ __________________________________________ Phone_____________________________________ E-mail address ______________________________

Individual requesting information Name_____________________________________ Address___________________________________ __________________________________________ Phone_____________________________________ E-mail address ______________________________

Specimen information (please be as complete as possible as this will assist us in identification):

· Why do you need the plant identified?________________________________________________________
· Date of collection:_____________________
· Cultivated? Yes or No.    If cultivated, originally obtained from where?_____________________________
· Habitat (plant community where found)______________________________________________________
· Location where this sample was growing (street address or direction/distance to nearest major landmark such as a highway, lake, town, etc.)__________________________________________________________
__________________________________________________________________________________________
· Frequency (how many in vicinity?): rare, occasional, frequent, common
· Habit: Herb, vine, shrub, or tree; Height____________  Other vegetative characters___________________
· Flower color/size__________________________  Fruit color/size/shape____________________________
· Additional information about specimen______________________________________________________
__________________________________________________________________________________________

Mailing information:
· Please prepare the specimen(s) as specified in our "Protocols for the Plant Identification Service."
· Send one form per sample to the address at the top of this sheet.

Identification (Please do not write in this space):
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________