Nongame Wildlife Grants Program – RFP Vendor and Prequalification Form

An * (asterisk) indicates a required field.

* Are you completing this form to prequalify? Yes   No

Salutation:	Dr. Mr. Ms. Mrs.
*First Name:		*Last Name:
*Affiliation:
Department:
*Address:
*City:
*State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming	*Zip Code:	–
*Telephone:	– –	Extension:
Fax:	– –
*E-mail:

* Have you received a grant from the Nongame Wildlife Grants Program or funds from the Florida Nongame Wildlife Trust Fund to support a project?  Yes   No

If you selected yes enter the most recent project title and the year it was initiated.

Year:

Title:

* Are you or your affiliation registered to conduct business with
the State of Florida?  Yes   No

Visit MyFloridaMarketPlace Web site to register or view status of a registration.

To receive notifications you may select up to three subjects of interest and/or one subject of interest for ‘Other’.

 Birds  Education  Fishes  Invertebrates  Mammals  Plants  Reptiles/Amphibians

Other:

Conservation Biology Fire Ecology Freshwater Ecology Genetics Habitat Evaluation/Management Horticulture Insect Marine Ecology Molluscs Restoration Ecology Systematics Toxicology Wetland Ecology Wildlife Diseases/Parasitology Wildlife Rehabilitation