Pacific Biodiversity Institute
Request for Assistance, Maps, Analysis or GIS Data

Instructions: Please save this file as a document, fill it out, fax, mail or email it to us at: 
Pacific Biodiversity Institute 
PO Box 298 
Winthrop, WA 98862
Fax 509-996-3778
Email: request@pacificbio.org

Name of your organization __________________________________				 

Name of contact person __________________________________				 

Street address __________________________________						 

Mailing address __________________________________					 

City ________________________			 State ____		 Zip ________	

Phone _____________	 Fax_____________		 Email ______________		

Web site ___________________________________________________				 

Title of your project __________________________________________________________	

Date submitted __________________	 

Please answer the following questions to aid us in prioritizing requests and determining how best to meet your needs.  Attach additional pages if needed. 

 Description of your project. Briefly summarize your project including: the work to be done, the geographic extent of the project, other groups coordinating on this project, similar work done to date. (If necessary, attach an additional page) 


Describe in detail the assistance requested from Pacific Biodiversity Institute (PBI). 







If you are requesting GIS based map products or landscape analysis, please describe exactly what you want to be included in the map(s) and/or analysis, and any details about how you want the information portrayed.  If you want us to make these decisions, please state this explicitly.  Use additional space if necessary.
  








Objectives. What do you hope to achieve with the completion of this project? How will assistance from PBI help you achieve these ends? 





Conservation and Environmental Benefits. What conservation and environmental benefits will result from your project? We will use this information to prioritize our requests. 


Community and Societal Benefits. What community and societal benefits will result from your project. We will use this information to prioritize our requests. 



Data Requirements. Indicate sources and status of data required - if known. Does data need processing to a different format? 




Time Frame. Describe the time frame of your project and the timing of when you will need assistance from PBI. 


Budget. 
What is your budget for your project? 



What are your sources of funding? 



Do you have funding to cover the assistance provided by PBI? 



If not, are you willing to help secure funding to help cover PBI's contribution to your project? 

Pacific Biodiversity Institute	 Request for Assistance	Page 1 of 1