Pollinator Habitat Documentation Form
To become one of the 1,001, please fill out the following form to document the pollinator habitat that you have created (don't forget to press submit at the bottom). When you have submitted the completed form, your name and town will appear in the garden count on our website. We will use the rest of the information anonymously to help other aspiring pollinator gardeners learn from what you have done. Thanks!
Town, State, Zip Code
Contact Info (Optional)
Phone or email. Will be kept private
Street address (Optional) To put you garden on map
Your actual address will not appear on the map. It will show as a dot.
1. Please list at least 3 native plants that you have planted to provide nectar and pollen to feed the pollinators. Mention the bloom times of the flowers if you know them from early spring to late fall. List as many plants as you want and wax eloquently about the ones you adore, or just list the names. If you know the genus and species, please share.
2. Please list at least two different host plants that you have planted for caterpillars. If you know which butterfly of moth caterpillars that the plants host, please share that information.
Visit "Food for Pollinators" Page and see section on Host Plants
3. Please list any ways you have enhanced your habitat to provide shelter, nest sites , water, puddling sites, or other improvements for pollinators. For more information go to
4. I will avoid using pesticides in my garden to provide a safe refuge for pollinators.
May we count you among our gardeners?
Yes. Please add me to the count and map, and add my name and town to the list.
I have sent photos of my garden for the gallery.
5. Briefly share something about your garden that you enjoy or that makes it special. OR, simply write your name or name your garden for the map. Note that the text in this box will appear when another gardener clicks your dot on the map.
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