Important Amphibian and Reptile Areas Nomination Form

Please complete as many of the sections as possible.  Incomplete submissions will still be considered, however, provide as much information as you can. If more space is required, simply type until you’re done.

Information provided to CARCN will be held in the strictest confidence and will only be published on the IMPARA web site following consultation with all affected parties.

Personal Information
Name:											
Organization/Affiliation:								
Address:										
											
City/Town:				Province/Territory:				
Postal Code:					
Telephone:				Fax:						
E-mail:						

Location
Site names:										
Province/Territory:			County/Region/District(s):			
Closest City/Town:				
UTM/Geographical Coordinates:							
											
Directions to Site:									
											
Maps (please attach):				
Other:											

Physical Description
Area (please specify units):								
Please describe the site, providing information of habitat type, vegetation type, presence and type of water bodies.

											

Land Ownership
If there are five or fewer owners, please list them.  Otherwise, an appropriate government representative, such as municipal council or regional district, is sufficient.
Name:											
Organization/Affiliation:								
Address:										
											
City/Town:				Province/Territory:				
Postal Code:					
Telephone:				Fax:						
E-mail:						

Are the land owners/managers aware of the importance of the site to amphibian and reptile conservation?
											
Are they aware of this site nomination, and if so did they participate in the process?

Amphibian and Reptile Species
In the table provided, please list all species of amphibians and reptiles recorded at the site, numbers of individuals of each species (if known), and any citations from which information was obtained (include the name of an observer if information is not published).  Provide a Literature Cited section at the end of the nomination.

Species	Status	No. of Individuals	References	

				

				

				

Other Species
Please list major, non-amphibian and non-reptile (especially rare or endemic) species present at the site and describe the importance of the site to these species.
Species	Status	Importance of Site	References	

				

Site Criteria
Under each category, please provide a description of how this site fulfills the Important Amphibian and Reptile Areas criteria.  If a category does not apply to this site then simply leave it blank (e.g. if there are no threatened species present then leave the Threatened Species category blank).

1. Species of Conservation Concern

											

											

2. High Species Diversity – state whether the site is of national, provincial, or 
regional importance

											

											

3. Important Life History Requirements

											

											

Human Impacts
Please describe how humans are impacting the site and the immediately surrounding areas in the following ways:

Current site usage (if any), e.g. industrial, residential, farming, logging, camping, recreation, etc. (please indicate relative importance).

											

Pollution, e.g. air, water, light, noise, etc.

											

Threats to habitat, e.g. development, habitat loss or degradation, succession, fire, etc.

											

Habitat conservation or restoration.

											

Recommended conservation actions for this area.
Please describe any conservation actions that are needed/recommended for this area.

											

Other Concerned Organizations
Please provide contact information for organizations or individuals that are involved in protection/conservation of this site, i.e. World Wildlife Fund Canada, Nature Conservancy Canada, Ducks Unlimited, Federation of Nova Scotia Naturalists.

											

Previous Work
Please list studies/documents/papers that have been derived from this site.  Please provide enough information so that such sources can be retrieved by CARCN.

											

Literature Cited
Please list any references cited in this nomination.