Nature in Your Neighbourhood site nomination form

First and last name

Email address

Phone number

Your address, including postcode

Which of above is your preferred contact method?

What is your interest in the site? For example: It's near my house, where I like to walk, near my place of work.

Name of proposed site

Where is the site you are nominating? Please note that sites must fall within the Staffordshire Moorlands District Council boundary. Town or region

Please put a pin on the map to show the site location. We want to give you as many options as possible to share locations important to you. Please complete as many prompts as you can, but don't worry if some are left blank. Those we need are marked with an asterisk (*)

Address

You can use the boxes below to provide further location information.

What is the nearest postcode of the site?

What is the grid reference of the site? This site: https://gridreferencefinder.com/ will find all of this information.

What is the What3Words for the site?

Name of owner/ manager of the site and contact details if known

What is the site? Nature reserve, grass verge etc.? Provide a brief description of the habitats, species and condition of the site.

Upload photos of the site here (maximum of 3)

Maximum 3 files.
15 MB limit.
Allowed types: gif, jpg, jpeg, png, svg.

Are you part of an existing community group? If yes please tell us about the group here. If not skip this section.

Please use this text box to provide any other information you'd like to share.

Would you be interested in being a Nature Champion? There are a variety of ways to be involved with the project on your nominated site. Please indicate below what you're interested in?

Take the lead on communicating with the project partnership

Practical management tasks

Surveying

Other

Please add information below

All of the above

Other

Where did you hear about the project?

Nature in Your Neighbourhood site nomination form

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