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Backyard Habitat Certification Application Form

Please complete form to be considered for CWF's Backyard Habitat Certification:

About you

Title:    
First and Last Name:  
Address:  
City:  
Province or Territory:  (2 character abbreviation)
Postal Code:  (no spaces)
Telephone:  
E-mail:  
Business Name (if applicable):

 

Name(s) to appear on certificate:

 

  

About the property

Property description (upload additional description below if more space is needed):  

Extensive description upload

  
Approximate size of property:   sq. ft.

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

 

 Shoreline Rural Suburban Urban

About the project 

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 (please separate by comma):

 

 

Meeting the needs of wildlife 

Check off the applicable response and give further information where indicated. Please provide as complete a plant list as possible.  

 

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:   
Recirculating stream    Pond with sloped sides and/or perches for wildlife  
Other (please specify):    Bird-bath 

 

 

    
Shelter through:   
"wild" area of tall grass    Bat house 
Brush piles    Rock piles  
Snag (standing dead tree)    Nesting boxes  
Logs       
Evergreen trees or shrubs, type/species:  
 
Deciduous trees or shrubs, type/species:  
 
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):      

 

 

  

Native plants and naturalization 

  

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:
meadow        forest     
other (please specify):  

Size of area:
  

 

  

Published by CWF

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

 

 

Confirmation 

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

 

 

Photos 

    
Please include up to five sketches and or photos of your garden indicating the general layout and photographs of key features.