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Nomination Form

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Complete as much of the requested information as possible. Leave blank what you are not sure of or do not know. Return the form to the Scott Somershoe, State Ornithologist, Tennessee Wildlife Resources Agency, P. O. Box 40747, Nashville, TN 37204 or Scott.Somershoe@state.tn.us. Thank you for participating.

Name of Site: _______________________________________________________________________________________

Location (including nearest town/county): ______________________________________________________________

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Description of Site (habitats, prominent features, etc.): ___________________________________________________

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Geographical coordinates (center of site):  Lat. _________________________ Long. __________________________

Elevation Range (feet):  Low_________ High__________  Size (acres): _______________

USGS 7.5’quad used to delineate site: __________________________________________________________________

Conservation Concerns: Classify as C (Critical), S (Serious), M (Major), P (Potential).
___Natural pests/disease   ___ Water pollution    ___ Air pollution    ___ Disturbance to birds (specify how)
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Commercial development    ___Residential development    ___Recreational development/overuse
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Hunting conflict    ___Fishing conflict     ___Introduced plants/animals    ___Deforestation     ___Forestation
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Extraction (mining/quarries)    ___Succession     ___Overgrazing    ___Pesticides 
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Agricultural  conversion   ___Predation   ___Damming     ___Drainage    ___Channelization 
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Other _______________________________________________________________________
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Other _______________________________________________________________________

Site Selection Criteria: Check appropriate boxes. See Criteria For Site Selection for detailed description of each category.

q 1. Endangered or Threatened species
q 2. In Need of Management species
q 3. Rare/Unique/Representative Habitat
q 4a. 500+ waterfowl winter or migration
q 4b. 25+ breeding pairs waders or 100+ individuals feeding/staging
q 4c. 1000+ migratory raptors (seasonal)
q 4d. 500+ shorebirds in migration
q 4e. 1000+ gulls or 100+ terns in winter or in migration
q 4g. Single species concentration
q 5. Long-term research and/or monitoring

Supporting ornithological data on categories checked in "Site Selection Criteria." Data needs to be no older than seven years, preferably five years and less. Use additional sheets if needed. Also submit any additional supporting data.

Site Criteria

Species/
Group

Season1

Avg. No Season

Max. No. Season

Years of Data

Source2

Ex: 4a.

Waterfowl

W

6,000

15,000

’97-’03

3,5,6

                                                                                                                                                                                             
       
       
       
       
       
       
       
       
       
Season1   B = Breeding, W = Wintering, SM = Spring Migration, FM = Fall Migration
Source 2  1-Atlas Breeding Birds of Tennessee 2-Breeding Bird Surveys 3-Christmas Bird Counts
4-Point Counts 5-Refuge Counts 6-Personal observations 7-Other (specify)

Land owner(s) and contact information, if known:   ______________________________________________________

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Submitted by and contact information: Name ___________________________________________________________

Address _____________________________________________________________________________________________

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Telephone _______________________________________  E-mail _____________________________________________

Names of individuals contributing to nominated site: ____________________________________________________

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Date ______________________________________

This page was last updated on 02/19/06.