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NOMINATION FORM

NOMINATOR INFORMATION Required Fields
Nominator Name: *
Organization:  
Address: *
City, State, Zip: *
Email: *
Phone: * Date:
     
SITE INFORMATION
Site Name: *
Address: *
City, State, Zip: *
Phone:   FAX:
County:   Size (acres):
Website URL:  
Directions to site:  
General description
of site:
 
     
SPECIES / HABITAT INFORMATION
  Spring Summer Fall Winter
Waterfowl
Shorebirds
Wading birds
Songbirds
Raptors
Game birds
Unknown
Signature species (bird/wildlife)
this site is known for:
 
Rare species (bird/wildlife)
found at this site:
 
Habitats (lakes, rivers, forest,
wetlands, bogs, grassland, etc.):
 
     
SITE ACCESS INFORMATION
Admission charges:  
Hours of operation:  
Seasonality of site:  
Site restrictions:  
     
SITE ASSESSMENT INFORMATION
Amenities:
   
  parking areas
  restrooms
  drinking fountain
  gravel trails
  boardwalks
  viewing platform/observation blind
  wildlife viewing window
  visitors center
  gift shop/book store
  equipment loans
  handicap accessible
  other
     
Activities:    
  camping
  swimming
  biking
  cultural attraction
  other
     
Food and lodging within
10 miles of site:
 
Historical/cultural attributes
at or near site:

 
Any other notable reasons
to visit site:

 
     
   
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