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Address of Pollinator Habitat *

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Line 2

City

State

Zip Code

Country

Mailing Address *

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Line 2

City

State

Zip Code

Country

Publicity

If yes, please list the name and email address of your local paper below:

Habitat Description

List the approximate property size: *

Area *

List approximate percentage of property dedicated to pollinators: *

Briefly describe your project and how it benefits butterflies and other pollinators: *

For educational facilities, briefly describe how the project is incorporated into the curriculum: *

Food

Besides two species of milkweed (two plant minimum for each species) for monarchs, you must provide host plants for five additional butterfly species. List the scientific name of the plant, whether or not it is native to Georgia (or your state or region), and the common or scientific name of the butterfly species that uses it as a host. Some plants may be host to more than one species of Lepidoptera. Make sure that the species you list is a pollinator.

Milkweed plant #1 scientific name: *

Native? *

Yes No

Common or scientific name of butterfly species: *

Susan's Test Page 2

Test Pollinator Habitat Certification Application

Applicant Information

Publicity

Habitat Description

Food