Site Nomination Form

Ownership of site to be nominated:  Municipal Private Organization Private Landowner Other

Name of site to be nominated:

Name of site to be nominated:  Free to the public Entry Fee Day Use Only RV Camping Available Tent Camping Available Handicap-accessible Off-road Parking Maintained Trails Primitive Trails No Trails Special Permit of permission required for entry (please describe):

Site Owner:

Site Phone:

Site E-mail:

Site website (if available):

Site mailing address:

Community

County:

Zip Code:

Latitude / Longitude (GPS Coordinates) if available:

Contact Person (if different from above):

Contact mailing address (if different from above):

Contact Community:

Contact County:

Contact Zip Code:

Location of site being nominated:
Provide specific directions to the site from the nearest community with services using the closest major highway. Include distances between turns. (Example: At Hwy #1 & County Road ‘A’ turn east onto County Road ‘A’ and go 4.3 miles to Sandhills Road ‘C’. At Sandhills Road ‘C’ turn south [right] and proceed 0.3 miles on to the entrance of the site.) Please identify which road segments are all-weather surface, minimal maintenance, or off-road. If possible please attach a copy of a county map showing exact location, or provide a detailed map showing the site, location and directions.

Site Description:

1. Total number of acres for site being nominated:

2. Habitats - Please check all habitat types available within the site being nominated. If possible, please quantify by stating the approximate number of acres of a given habitat type (or number of ponds, miles of river etc.). If you are uncertain, simply check those categories for which you are confident, or you may skip this section and simply describe the habitat available in the habitat description section. For questions, please contact (the e-mail that will go to the nomination review team: Paul, Linda Brown, Clem, Kelly).

Wooded Habitats:
Forest (Canopies higher than 17 ft. and over 60% cover)
 Lowland (floodplain) Deciduous Woodland Upland Coniferous Woodland Upland Deciduous Woodland

Woodland (Canopies higher than 17 ft. and 25-60% cover)
 Lowland (floodplain) Deciduous Woodland Upland Coniferous Woodland Upland Deciduous Woodland

Shrubland (Shrubs under 17 ft: more than 25% canopy cover)
 Lowland (floodplain) Deciduous Woodland Upland Coniferous Woodland Upland Deciduous Woodland

Grassland Habitats: (Habitats dominated by non-woody plants: canopy cover over 25%)
 Lowland Tall Grass Prairies Upland Tall Grass Prairies Sand Hill Prairies Mixed Grass Prairies Short Grass Prairies

Sparse Vegetation: (Plant cover of less than 25%, highly variable topography
 Badlands(Steep, eroded slopes) Dry Cliffs / Rock Cavities (Very steep rock escarpments) Rock Outcrops (Moderate to fairly steep rock escarpments) Sand or Gravel Flats (Barren riverine, lacustrine edges & bars)

Wetland Habitats: (Aquatic and semi-aquatic habitats
 Alkaline (Saline) Wetlands Playa (Seasonal) Wetlands Wet Meadow / Marsh Open Water, Lakes & Reservoirs Open Water, Streams & Rivers Swamps / Wooded Backwaters (Oxbows, flooded trees) Open Shoreline (Lightly vegetated shores)

Other Habitats: (Variable plant life & cover extend
 Cropland Prairie Dog Town Urban / Parks / Bridges / Human Constructions Woodland Edge (Woodlands edged by shrubs & herbaceous plants)

3. Facilities (Toilets, drinking water, telephone, shelter, picnic tables, etc.)

4. Services (Food, lodging, fuel, supplies, outfitters, etc. May describe distance to nearby facilities such as gas stations, restaurants, motels, shops...)

5. Additional Activities (Tours, programs, canoeing, cycling, hunting, fishing, etc.)

6. Site checklist of birds

Site Attractions: In 500 words or less what makes this site attractive to people engaged in bird watching and other wildlife viewing activities. What time of year is best? (e.g. year round, spring migration, summer, fall migration, winter.) If possible list which birds and wildlife can be viewed, along with any tips on where or when to find them on your property. For example: wooded area next to parking lot for warblers, prairie dog town for burrowing owls, marsh area for shore birds & waterfowl. If available, please include any information about rare or unusual species of birds, wildlife, and plants that can be viewed, along with the seasons and locations on your property in which they occur.

Guided Bird Walks: Are there any birding clubs, Audubon groups, or private individuals available to lead pre-arranged guided tours for groups and individuals upon request? If so, please describe.