Blue Ridge Conservation Pollinator Garden Application FormComplete the form below to submit your application to be certified as a Blue Ridge Conservation Garden! Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Is the garden within the Central Virginia Planning District? We welcome all that are interested in learning about the program to stay and read but this particular program is for the Central Virginia Planning District (City of Lynchburg, Amherst, Bedford and Campbell Counties). Is the garden being certified at this address? Yes No If no, please submit the address for the garden being certified here: SECTION 1: PROVIDE FOOD Mandatory Food Requirements: Choose plants that provide pollen and nectar sources from early spring to late fall and at least two of those should be HOST PLANTS for caterpillars. NATIVE TREES: Common Name (Botanical Name) TREES AND SHRUBS: Click 4 different species of trees and shrubs (any combination) from the following list of trees AND/OR shrubs. Red Maple (Acer rubrum) Host Plant Sugar Maple (Acer saccharum) Host Plant Yellow Buckeye / Horse Chestnut (Aesculus flava) Host Plant Hazel Alder (Alnus serrulata) Downy Serviceberry (Amelanchier arborea) Host Plant Pawpaw (Asimina triloba) Host Plant River Birch (Betula nigra) Host Plant American Hornbeam (Carpinus caroliniana) Host Plant Pignut Hickory (Carya glabra) Host Plant Shagbark Hickory (Carya ovata) Host Plant Common Hackberry (Celtis occidentalis) Host Plant Eastern Redbud (Cercis canadensis) Host Plant Fringetree (Chionanthus virginicus) Host Plant Flowering Dogwood (Cornus florida) Host Plant Green Hawthorn (Crataegus viridis) Host Plant American Beech (Fagus grandifolia) Host Plant Black Walnut (Juglans nigra) Host Plant Eastern Red Cedar (Juniperus virginiana) Host Plant Tulip Poplar (Liriodendron tulipifera) Host Plant Cucumber Tree (Magnolia acuminata) Host Plant Umbrella Tree (Magnolia tripetala) Host Plant Mulberry (Morus rubra) Host Eastern Hop Hornbeam (Ostrya virginiana) Host Plant Sourwood (Oxydrendrum arboretum) Host Plant American Sycamore (Plantus occidentalis) Host Plant Chicksaw (Prunus angustifolia) Host Plant Chokecherry (Prunus virginiana and serotina) Host Plant White Oak (Quercus alba) Host Plant Swamp White Oak (Quercus bicolor) Host Plant Southern Red Oak (Quercus falcata) Host Plant Willow Oak (Quercus phellos) Host Plant Black Willow (Salix nigra) Host Plant American Basswood or Linden (Tilus americana) Host Plant NATIVE SHRUBS: Common Name (Botanical Name) New Jersey Tea (Ceanothus americanus) Host Plant Buttonbush (Cephalanthus occidentalis) Host Plant Eastern Leatherwood (Dirca palustris) Eastern Teaberry (Gaultheria procumbens) American Witch Hazel (Hamamelis virginiana) Shrubby St. John's Wort (Hypericum prolificum) Mountain Holly (Ilex montana) Winterberry (Ilex verticilata) Mountain Laurel (Kalmia latifolia) Spicebush (Lindera benzoin) Host Plant Scentless Mock Orange (Philadelphus inodorus) Host Plant Flame Azalea (Rhododendron calendulaceum) Host Plant Pink Azalea (Rhododendron periclymenoides) Host Plant Early Azalea (Rhododendron prinophyllum) Host Plant Rose (Rosa palustris) American Black Elderberry (Sambucus nigra canadensis) Coralberry (Symphoricarpos orbiculatus) Mapleleaf Viburnum (Viburnum acerifolium) Host Plant Southern Arrowood Viburnum (viburnum dentatum) Host Plant Possumhaw Virburnum (Viburnum nudum) Blackhaw Virburnum (Viburnum prunifolium) Host Plant Other natives not listed above? Please list here: NATIVE PERENNIAL FLOWERS: : Common Name (Botanical Name) Early Season Bloom (April/May/June) Need a minimum of 2: Colombine (Aquilegia canadensis) Host Plant Jack in the Pulpit (Arisaema triphyllum) Blue Wild Indigo (Baptisia australis) Host Plant Spurge (Euphorbia corollata) Bettleweed (Galax urceolata) Woodland Geranium (Geranium maculatum) Host Plant American Alumroot (Heuchera americana) Dwarf Crested Iris (Iris cristata) Virginia Bluebells (Mertensia virginica) Golden Ragwort (Packera aurea) Host Plant Arrow Arum (Peltandra virginica) Eastern Gray Beardtongue (Penstemon carescens) Host Plant Foxglove (Penstemon digitalis) Solomon’s Seal (Polygonatum biflorum) Foamflower White (Tiarella cordifolia) White Trillium (Trillium grandiflorum) Trillium (Trillium sessile) Other natives not listed above? Please list here: NATIVE PERENNIAL FLOWERS: : Common Name (Botanical Name) Mid-Season Bloom (June-August) Need a minimum of 2: Yarrow (Achillea millefolium) Purple Hyssop (Agastache scrophularifolia) Butterfly Weed (Asclepaias tuberosa) Host Plant Swamp Milkweed (Asclepias incarnata) Host Plant Common Milkweed, Purple (Asclepias syriaca) Host Plant Lady Fern (Athyrium asplenioides) Bellflower (Campanula divaricata) Turtlehead (Chelone glabra) Lobed tickseed (Coreopsis auriculata) Lanceleaf tickseed (Coreopsis lanceolata) Tickseed (Coreopsis major) Host Plant Star tickseed (Coreopsis pubescens) Whorled tickseed (Coreopsis verticillata) Joe Pye Weed (Eupatorium maculatum) Host Plant Carolina Geranium (Geranium carolinaiam) Host Plant Oxeye Sunflower (Heliopsis helianthoides) Blazing Star, purple (Liatris squarrosa) Turk's Cap Lily (Lillium superbum) Cardinal Flower (Lobelia cardinalis) Great Blue Lobelia (Lobelia siphilitica) Yellow Loosestrife (Lysimachia ciliata) Basil Beebalm (Monarda clinopodia) Wild Bergamot (Monarda fistulosa) Spotted Beebalm, Horsemint (Monarda punctuate) Narrow-leaf Sundrops (Oenothra fruiticosa) Host Plant Easter Smooth Beardtongue (Penstemon spectabilis) Host Plant Woodland Phlox (Phlox divaricata) Wildflower phlox (Phlox latifolia) Mountain Mint (Pycnanthemum tenuifolium) Black Eyed Susan (Rudbekia hirta) Host Plant Brown Eyed Susan (Rudbeckia triloba) Host Plant Lyre-lea Salvia (Salvia lyrata) Virginia Spiderwort (Tradescantia virginiana) Blue Vervain (Verbena hastata) Narrowleaf Verbena (Verbena simplex) Host Plant Culver’s Root (Veronicastrum virginicum) Other natives not listed above? Please list here: NATIVE PERENNIAL FLOWERS: : Common Name (Botanical Name) Late bloom time (August-October) Need a minimum of 2: Yellow Hyssop (Agastache nepetoides) Wild Snakeroot (Ageratina altissima) Lanceleaf Anemone (Anemonie lancifolia) Tall Anemone (Anemonie virginiana) White Wood Aster (Eurybia divaricate) Host Plant Beeblossom (Oenothera guara) Host Plant Purpledisk sunflower (Helianthus atrorubens) Ten-petal sunflower (Helianthus decapetalus) Woodland sunflower (Helianthus divaricatus) Smooth sunflower (Helianthus laevigatus) Small woodland sunflower (Helianthus microcephalus) Paleleaf woodland sunflower (Helianthus strumosus) Obedient Plant, White, Pink, Purple (Physostegia virginiana) Wild Stonecrop (Sedum ternatum) Goldenrod (Solidago rugosa) Host Plant Heart Leaved Aster (Symphoytricum cordifolium) Smooth Blue Aster (Symphyotricum concinnum) Purplestem Aster (Symphyotrichum puniceum) White Vervain (Verbena urticifolia) New York Ironweed (Vernonia noveboracensis) Other natives not listed above? Please list here: STEP 2: PROVIDE WATER Water is needed by all pollinators. How do you provide water to your pollinators? Please check all that apply below as sources of water. You need at least a minimum of one source. Birdbath or shallow water source Butterfly puddling area Water garden/pond Stream Spring STEP 3: PROVIDE SHELTER Pollinators need places to build a nest and to spend the winter or overwinter. The following is a list of ways to provide nesting and overwintering sites. Please check all that apply to your garden. Need a minimum of two. Spaces of bare ground Rock pile/wall Dead wood Man-made nesting shelter (like boxes, tubes, flower pots, holes in wood) Leave garden clean-up till spring STEP 4: SAFEGUARDING POLLINATOR HABITATS ACTION ONE: REDUCE INVASIVE PLANTS Invasive plants threaten pollinators by endangering and reducing the availability of native plants. These native plant food sources are vital for our native bees and butterflies that depend on them for survival. Invasive plants that move from our yards and gardens to woodlands threaten the diversity of the natural habitat. Many of these invasive plants take over the habitat and spread without control, thereby crowding out our native plants. We can help sustain our native plants by not planting invasives and removing any existing invasives on our properties and gardens. How do you safeguard pollinator habitat in your garden and property? See list of invasive plants in the Piedmont region of Virginia at this website: https://www.dcr.virginia.gov/natural-heritage/ip I avoid acquiring invasive ornamental plants I have removed or am removing invasive plants currently on my property Please indicate which common invasive plants you are removing or controlling: Autumn Olive English Ivy Bamboo Fig Buttercup Burning Bush Garlic Mustard Bush Honeysuckles Japanese Barberry Butterfly Bush Japanese Honeysuckle Callery Pear Japanese Knotweed Chinese/Oriental Bittersweet Japanese Stiltgrass Chinese/Japanese Wisteria Kudzu Crown Vetch Multiflora Rose Norway Maple Russian Olive Privet Tree of Heaven Purple Loosestrife ACTION TWO: REDUCE PESTICIDE AND HERBICIDE USE Pesticide use can have adverse effect on pollinators and actually harm more pollinators if the pollinator takes the pesticide back to a nest. Also, it has been shown that indiscriminate broad use of herbicides to control weeds can also affect pollinators. The use of Integrated Pest Management (IPM) to control pests in your garden is the preferred method you should follow. To protect our pollinators please check all that apply below. I don’t use pesticides I don't use broad spectrum pesticides I follow integrated pest management (IPM) to control pests in my garden, but always do the following in my garden: Clearly identify the pest before taking action Try a mechanical means like picking a pest off the plant and killing as my first control Use less toxic pesticides such as horticultural oil and insecticidal soap Always follow label directions Never spray plants in bloom Target spray only the problem spots GARDEN INFORMATION The following information is collected just to identify the type of property or garden you are certifying. In what type of area is your property located? Urban Suburban Rural Estimate the percentage of your property planted in pollinator friendly plants: Choose the option that best describes your garden: Home Business Apartment Farm Condominium Community Garden School Other If other, please describe: SUBMITTING YOUR APPLICATION Certify Your Information: By entering your full name below, you indicate that you agree with the following statement: I certify that all the information provided above is true and that I will strive to use pollinator friendly practices in my garden. Thank you for submitting your application. Please use the remit payment at the bottom of the page to pay the $20 fee for your sign. You will be contacted shortly from Blue Ridge Conservation about arranging for the sign pick-up.Thank you for your commitment to sustainable environments. Alternatively, to complete your application by mail, please fill out the PDF below and submit your $20.00 check payable to Hillside Garden Club Mail to:Mail to: Kris Lloyd, 3525 Otterview Pl., Lynchburg, VA 24503 Printable Application