Specimen Form

Insect, Disease, and Plant Specimen

Identification Request Form

Type of sample submitted:



Insect Identification

Plant Identification

Plant Symptoms

What part of plant is affected? (check all that apply)







Where are the symptoms located? (check all that apply)







How long have you noticed the symptoms?





Where is the plant located? (check all that apply)







Have you used any chemical treatments (pesticides, fertilizers, etc.)?



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