Common Name: _______________________________________________________

Scientific Name: _______________________________________________________

Number of Individuals: ____________ Gender: ___________ Age: _____________

Locality: ______________________________________________________________

________________________State: ________________County: ________________

Date(s) observed: _____________________ Time: __________________________

Reporting Observer: ____________________________________________________

Other Observers: ______________________________________________________

Light Conditions: ______________________________________________________

Optical Equipment: ____________________________________________________

Distance to bird(s): ____________________________________________________

Duration of Observation: _______________________________________________

Habitat: ______________________________________________________________

Behavior: ____________________________________________________________

_____________________________________________________________________

Description: __________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Voice: _______________________________________________________________

Similar Species (and why they were ruled out): _____________________________

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Photographs: _________________________________________________________

References: __________________________________________________________

Description from: ____Contemporaneous notes*; ____Later notes*; ____Memory

*Please attach a copy. Provide as many details as possible.

Experience with Species: _______________________________________________

______________________________________________________________________

Signature: ____________________________________Date: __________________