form

2006 OSU Master Gardener™
ONLINE SUBMISSION Intake Form for Yamhill County

Today's Date

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I have a question only - no samples or images
I am sending images with this form
I have physical samples to accompany this form. I will bring them to the Extension office.

Your Full Name *

Address *

City

Zip Code

Phone Number

Email Address

Type of Inquiry. If you have several different questions or samples, please submit a separate form for each one.

Plant Identification
Disease
Diagnosis
General Health
Insect/Animal Identification
Insect Infestation
Other Identification
Other (Please describe below)

If Other (Please describe)

Specifics of Inquiry

Identification of material, if known (e.g. salal, blueberry, spider)

Location of material (e.g. north side of house near driveway)

General environment (e.g. moist from water seepage, afternoon sun)

Describe problem in detail

Is the problem affecting more than one specimen?

No
Yes (Describe below if yes)

Enter your description here.

Is there any other information we should know? If so, please describe.

You can upload an image file here

Second file to upload

Third file to upload

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