Name *

First Name

Last Name

Client Name *

First Name

Last Name

County *

Arlington/City of Alexandria

Fairfax

Loudoun

Prince William

Fauquier

Rappahannock

Other; please include in your comments.

Visit Results *

Note: This field has been updated to include your recommendations for certification AND withdrawls and non-responses.

I recommend this property for certification upon completion of the application with observation of sanctuary species

This property shows promise but needs more work than just observing species e.g. more native plants, invasives removal, managing water issues

This property or property owner/manager is not likely to achieve certification. Please add your notes to the Challenges section below.Shows Promise

This client no longer wants a visit. If appropriate, add a note in the Additional Comments section below.

This client didn't respond to multiple emails and/or phone calls

Date of Site Visit

MM

DD

YYYY

Client wants a Sanctuary Sign

Yes

No