Natural Heritage Rare Animal Species Reporting Form 



This form is used to report a personal field sighting of a rare species tracked by the Montana Natural Heritage 

 Program. It may also be used to summarize locational information from a published or unpublished report, .\njmal 

 species tracked include those on the U.S. Fish and Wildlife Service Threatened, Endangered or Candidate Lists, the 

 U.S. Forest Senice Sensitive List, the Montana Department of Fish, Wildlife and Parks Species of Special Interest or 

 Concern List, and the Heritage Program Animal Species of Special Concern List. The Heritage Program can provide 

 a copy of the List upwn request. For most bird species, only reports of confirmed breeding are requested. 



In order for this form to be processed, the sections preceded by two asterisks (**) must be completed. 



Send completed form to: Montana Natural Heritage Program, 1515 E 6th Ave., PO Box 201800, Helena MT 59620. 



Scientific Name **Common Name 



Lx>cation: 



Location Map: A mapped location of the occurrence should accompany this form. The ideal format is to locate the 

 site on a photocopied section of a USGS 7.5 minute topo map; Forest Service, BLM, or other maps may be used. Be 

 sure to provide the name of the map. 



County: Township: Range: Section: 



''Directions to Site: Describe in detail how to get to the site from a readily located permanent landmark such as a 

 road intersection. 



Biology/Habitat 



"Date and Approximate Time of the Observation: 



* 'Number of Individuals Obser\'ed: 



n 1-5 D5-10 n 11-50 D 51-100 n 101-1000 a > 1000 



If possible, provide the exact number of individuals: 



Life Stages Present: Check off the life stages observed or provide an estimate of the numbers of individuals for 

 each Ufe stage: 



eggs larvae immature adult female adult male adult, sex unknown 



Comments: 



Additional Status Information: What else was observed? Provide information on the behavior of the species 

 particiilarly that which could indicate or confirm breeding at the site. For birds this could include singing males, 

 carrying nest material/food, dependant young obsen'ed, entry of ad\ilts into possible nesting cavity, etc. 



Associated Species: List any associated species such as predators, prey, food plants, host species, or additional rare 

 species observed at the site. 



Required Field 



