Backyard Habitat Certification
Application Form

Please print and mail the completed form.

Mr  Ms  Mrs
Name of individual:
Number and Street:
City:
Province / Territory:
Postal Code:
Telephone:
E-mail Address:

Name(s) to appear on certificate:

Property description (attach additional sheets to this form if more space is needed).

Approximate size of property: sq. ft acres

Check off the best description(s) of your property location:

Urban Suburban Rural Shoreline

Briefly describe your garden project and how it benefits wildlife.

How long have you been working on this project?

List some of the wildlife that currently visit your property:

Check off the applicable response and give further information where indicated.
Please provide as complete a plant list as possible. If more space is required please use additional paper.

My garden provides wildlife with:
Food through:
Fruit-bearing shrubs,trees, & vines, type/species:
Flowering trees, shrubs, & perennials for pollinators, type/species:

Nut or seed-bearing trees & shrubs, type/species:

Seed-bearing perennials left through the winter, type/species:
Feeders, type(s):
Other (please specify):
Water through:
Pond with sloped sides and/or perches for wildlife
Bird-bath Recirculating stream
Other (please specify):
Shelter through:
Evergreen trees or shrubs, type/species:
Deciduous trees or shrubs, type/species:
"wild" area of tall grass Brush piles
Snag (standing dead tree) Logs
Rock piles Nesting boxes
Bat house
Other (please specify):
Space through a diversity of vegetation:
Grass Flowers
Shrubs Small trees
Tall trees
My garden is safe for wildlife because I:
don't use chemical insecticides or herbicides
My garden is earth-friendly because I:
use a rain barrel
water my lawn no more than once per week if necessary
use natural soil amendments (such as compost or well-aged manure)
have my own composter
leave grass clippings on my lawn
use fall leaves to mulch beds or as compost
other (please specify):

I have included the following trees, shrubs, or perennials that are native to my region.
Please list species names, scientific if possible, so that we can verify (e.g. eastern white cedar (thuja occidentalis) instead of just cedar or sugar maple (acer saccharum) instead of just maple. Please note: hosta, peony (except p. brownii), daylily, and lily-of-the-valley (convallaria majalis) are not native.
(For ideas on what is native to your region see our Plant Encyclopedia at www.wildaboutgardening.org).

I have left wild or am naturalizing extensive areas of my property as:

forest   meadow   other

Size of area:

Please include a sketch of your garden indicating the general layout and photographs of key features.

CWF occasionally features outstanding projects in our Canadian Wildlife magazine, Bulletin newsletter, other promotional material and/or on our Web sites.
I authorize CWF to use the information and photographs provided in the above-mentioned resources. Photography credits should be given to:
I do not want my project featured in any resources.

Please note: Photographs cannot be returned.

I confirm that the information contained in this application is true and accurate to the best of my knowledge.

Signature
Date


Please mail the completed form, along with sketches and photographs to:
 Backyard Habitat Certification
Canadian Wildlife Federation
350 Michael Cowpland Drive
Kanata, Ontario
K2M 2W1