Your Name *

First Name

Last Name

Your Phone

(###)

###

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Is there a sidewalk next to this area? *

Yes

No

Other. Explain using the last field on this form.

My community association Board has approved this project to proceed if we are given this grant. (Y/N) *

Yes

No

We have taken photos of the area in question and will email them to aah@audubonva.org. *

Yes

No

We agree to prepare and submit a maintenance plan for our entrance planting by November 30, 2021 and to maintain the planting for at least 5 years

Yes

No

We agree to post a sign that says, “Native plants support birds and other wildlife” by the project (Audubon-at-Home will provide an 8.5 x 11 inch sign, though you can make it larger if you like.) *

Yes

No