Contact Information:  
	Ann Bucklin, Professor and Director
	New Hampshire Sea Grant Program
	142 Morse Hall
	Durham, NH 03824
	Tel: (603) 862-0122;  Fax: (603) 862-0243
	Email: acb@christa.unh.edu


      INFORMATION FOR COOPERATIVE RESEARCH PROJECT PARTICIPANTS

FISHING VESSEL INFORMATION

	Vessel name: 

	Vessel owner: 

	Home port: 

	Documentation #: 

	State registration #:   

	Length overall (ft): 

	Beam (ft): 

	Draft (ft): 

	Tonnage: 

	HP:  

	Engine make: 

	Engine model: 

	Safety equipment: 
                       Survival suits: 
                        Life rafts: 
                        Emergency radio equipment: 
                        Fire fighting and damage control:                       
		Is the vessel owner operated? 

	Additional Comments: 

OPERATOR CREDENTIALS AND EXPERIENCE
	Years experience as operator of vessels: 

	Years experience as operator of this vessel: 

	Describe licenses and certifications held: 

	Organizational affiliations:

	Previous research experience:

	Please list names of researchers you have taken out:

	Describe any research you are particularly interested in,   
                      or research you would like to see initiated:

	Coast Guard safety sticker: 

VESSEL CONTACT INFORMATION 
	Name

	Address

	Business Phone:

	Mobile Phone: 

	Fax: 

	Email:

VESSEL SPECIFICATIONS

	Fishing rigs: 

	Deck Equipment: 
                        Winches and capacity: 
                        A-frames: 
                        Mast/Boom: 
                        Reels: 
                        Other: 

VESSEL SPECIFICATIONS (continued)
		Can scientific gear be accommodated on deck? 
			Square footage: 
		Wet lab space? 
			Where? 
			Square footage: 
		Dry lab space? 
		Storage space? 
		Steaming speed: 
		Steerage minimum: 
		Electrical system and source: 

	Vessel Accommodations
		Days capable of staying at sea: 
		Number of berths: 
		Normal Crew: 

	Facilities: 
		Head: 
		Shower:     
                   
	Vessel Permits and Licenses
		Primary areas fished: 
		Primary fisheries: 
		State permits/licenses: 
		Federal fishery permits:
		Restrictions/limitations:   

	Vessel Electronics
		GPS:   
		Sounder(s): 
		Sonar(s): 
		Additional transducers: 
		Electronic charting: 
		Radar 
		VHF 
		Single Side Band 
		Cellular Phone 
		Computer 
		Auto pilot 

	Insurance Information
		Hull: 
		P & I:  
		Coverage Limit: