Audubon at Home
Application for Wildlife Sanctuary Certification

Contact Information / Organization / Property Location	
Name	 	
Street Address	 	
City	 	County	 	Zip	 	
E-Mail Address	 	Phone	 	Mobile	 	
						
Type of Property:                             	( )	Property Size:		
Residence		Approximate size of the site (in acres):		
HOA/Community Common Area		
Approximate size of habitat within the site to be 		
School				
Faith Community		certified (in square feet or acres):		
Business				
Government		The habitat to be certified is New, Existing or Both?		
Parkland				
Other (specify)				

Thank you for taking the challenge to create a wildlife sanctuary.  Here is your roadmap to success:

1.	Review this application for required habitat practices and features. Filling in the application will help you identify gaps you will work on to attain certification. Use the resources on our website at AudubonVA.org/Audubon-at-Home  to learn about native plants and the insects, birds and other wildlife that depend on them. 
2.	Request a no-cost Audubon at Home visit if you need support getting started.  Your AAH Ambassador will offer personalized advice on habitat practices and native plants suitable for your property. Request the visit by clicking on your county on AudubonVA.org/Wildlife-Sanctuary-Program/  
3.	Take steps to improve your wildlife habitat and to attract at least 10 Sanctuary Species. 
4.	When you have attracted at least 10 Sanctuary Species:  Complete this form.  If you have not yet been assigned an Ambassador, request a visit for certification by clicking on your county on AudubonVA.org/Wildlife-Sanctuary-Program/  

Habitat Features

Indicate the habitat features you already have and those you are planning to add to your habitat.   At least 2 of the bolded and starred (*) items are required for AAH Wildlife Sanctuary Certification.

	Current
( )	Planned
( )		Current
( )	Planned
( )	
*Water Feature (Bird Bath, 
 Stream, etc.)			Snags (Standing Dead Trees)			
*Rain Garden			Native Bee Boxes /
Exposed Soil			
*Native Pollinator Garden or   
 Meadow			Bird Feeders			
*Native Shrubs/Trees			Nest Boxes			
Brush Shelter			Other (Specify below)			

Healthy Yard Pledge

Check the habitat best practices that you have already adopted or are planning to adopt.  At least 2 of the bolded and starred (*) items are required for AAH Wildlife Sanctuary Certification. 

Audubon at Home Practices	I have done this
( )	I plan to do this
( )	
*Reduce pesticide and fertilizer use			
*Conserve water and protect water quality			
*Remove invasive non-native plants			
*Plant species native to our area			
*Reduce lawn coverage area			
*Support birds and other wildlife  
•	Strongly encourage keeping cats indoors 
•	Guard against human-made hazards like window collisions, light and noise pollution and poisonous pest traps			

Let the animals decide!

After all the work you have done preparing your habitat, the animals make the decisions about whether it supports them.  Our Sanctuary Species list is comprised of species that need our support here in Northern Virginia. Record your observations below.  The 42 sanctuary species and species groups are listed below. Images, identification help, fact sheets and other resources may be found on our website at  AudubonVA.org/Sanctuary-Species.  

Sanctuary Species and Species Groups
Birds
•	American Goldfinch
•	Baltimore Oriole
•	Blue-gray Gnatcatcher
•	Carolina Chickadee
•	Carolina Wren
•	Cedar Waxwing
•	Eastern Bluebird
•	Eastern Meadowlark
•	Eastern Towhee
•	Gray Catbird
•	Green Heron
•	Hawk Species
•	Owl Species
•	Ruby-throated Hummingbird
•	Tree Swallow
•	Tufted Titmouse
•	Warbler Species
•	Woodpecker Species
•	Wood Thrush	Butterflies & Moths
•	Fritillary Butterfly Species
•	Monarch Butterfly
•	Swallowtail Butterfly Species
•	Giant Silk Moth Species
•	Clearwing Moth Species

Other Invertebrates 
•	Native Bee Species
•	Dragonfly and Damselfly Species
•	Hover Fly
•	Lady Beetle Species
•	Lightning Bugs
•	Six-spotted Tiger Beetle
•	Crab Spider Species
•	Orb Spider Species
•	Wolf Spider Species	Amphibians
•	Frog & Toad Species
•	Salamander Species

Reptiles
•	Eastern Box Turtle
•	Eastern Fence Lizard
•	Five-lined Skink
•	Snake Species

Mammals
•	Little Brown Bat
•	Short-tailed Shrew
•	Southern Flying Squirrel

Wildlife Sanctuary Species Observed
•	List no more than one species from a species group, e.g. only one species of woodpecker, etc.
•	Flyovers do not count unless observed feeding.  Hawks and bats may be observed feeding, for example.
•	Species should be observed within a 3-year period. 
		
	Date Observed	Species/Species Group	Species’ Behavior or Usage of Your Habitat	Comments	
1.			      		
2.    		      	      	      	
3.    		      	      	      	
4.      		      	      	      	
5.      		      	      	      	
6.      		      	      	      	
7.      		      	      	      	
8.      		      	      	      	
9.      		      	      	      	
10.      		      	      	      	

Sign and date your completed application and submit to us via email at AAH@AudubonVA.org or by mailing a hardcopy to ASNV, Audubon at Home, 11100 Wildlife Center Drive, Suite 100, Reston, VA 20190.  

We encourage you to purchase a Certified Wildlife Sanctuary yard sign to celebrate your achievement and to let others know about the program, thereby increasing the impact of the sanctuary you have created. The cost is $35 including tax. You may use our PayPal page (your official notification will have the link for payment) or include a check when you mail your completed application.  

Applicant Signature (electronic accepted)	Date	Audubon at Home Ambassador	Date	

				

We will celebrate your certification with you by adding your property –without your name or street address -- to our Geographic Information System (GIS) Certified Sanctuary map on our website. This helps to show the progress our communities are making in creating contiguous areas of urban/suburban wildlife habitat and helps us to identify areas where we should focus our efforts to reach property owners. 

From time to time we may contact our clients with a survey to find out what has changed in your wildlife sanctuary since you were certified. We hope you will participate in these surveys to help us learn and to improve our program. 

We encourage you to share your experience with your community. We will gladly give presentations on creating habitat.  Contact us through your AAH Ambassador or at AudubonVA.org/Contact-AAH to learn more about how you can get involved.

The work of the Audubon At Home program is delivered through critical partnerships with regional volunteer conservation organizations: Arlington Regional Master Naturalists, Fairfax Master Naturalists, Loudoun Wildlife Conservancy and Prince William Master Gardeners.  Together we are Audubon At Home.   

Our special thanks to the Potowmack Chapter of the Virginia Native Plant Society 
and to the National Audubon Society Plants for Birds Program