BIRD & POLLINATOR FRIENDLY SPACES
Certification Programme — Registration Form Nature Rwanda · www.naturerwanda.org
SECTION 1 — APPLICANT DETAILS
Primary contact responsiblefor this application (fields marked *are required)
Name
*
First Name
Last Name
Email
*
Whatsapp Number
Please enter a valid phone number.
Format: (078) 000-0000.
Role / Position
Organization Name (if applicable)
SECTION 2 — SPACE INFORMATION
Details about the space applying for certification
Name of Space
*
Approximate Size (m² or hectares)
*
Physical Address / Location Description
*
Street Address
District
Sector
Cell / Village
Type of Space
*
Household / Home Garden
Hotel / Lodge / Restaurant
Health Clinic / Hospital
School / University
Government / Public Institution
Business / Office
Community Park / Green Space
Other
If 'Other', please specify:
SECTION 3 — CERTIFICATION LEVEL SOUGHT
Choose the certification level(Entry / Medium / High)ENTRY
ENTRY (Getting Started)
MEDIUM (Growing Your Impact)
HIGH(Leading the Way)
SECTION 4 — THREAT-REDUCTION ACTIONS
Tick all actions already implemented at your space
Type a question
*
No chemical pesticides, insecticides, or rodenticides used
Window collision deterrents applied (stickers, screens, UV film)
Outdoor lighting reduced or shielded downward at night
Low-speed zones or barriers to reduce vehicle strike risk
Glue traps removed or never deployed
No live-trapping, netting, or caging of wild birds/pollinators
Cats/dogs kept indoors or on leads during nesting seasons
SECTION 5 — HABITAT RESTORATION ACTIONS
Tick all actions already in place or planned within the next 3 months
Type a question
*
hrubs, or herbaceous species planted
Bird bath / water feature established (water refreshed every 2 days)
Wild garden corner maintained with natural ground cover
Chemical fertilisers replaced with compost or organic matter
Invasive exotic plants removed and replaced with native alternatives
Nest boxes or insect hotels installed
Native plant species already established or planned:
SECTION 6 — COMMUNITY ENGAGEMENT & MONITORING
At least one person trained in basic bird/pollinator identification
Wildlife observations submitted via iNaturalist
Participating in the Nature Rwanda WhatsApp monitoring network
Certification sign or badge displayed at the space
Nature walks or wildlife awareness events hosted
Supporting neighbours or partners to begin certification
Current observation / monitoring frequency:
Monthly
Twice per week
Continuous / systematic
Not yet started
iNaturalist Username (if registered):
Company Contact Number:
SECTION 7 — SUPPORTING EVIDENCE TO BE SUBMITTED
Photographs of space, plantings, and threat-reduction measures
Wildlife observation records (date, species, location)
Completed Nature Rwanda self-assessment checklist
Sketch map or satellite image of the space
SECTION 8 — ADDITIONAL INTERESTS & SUPPORT
I am interested in becoming a Nature Rwanda verifier
I would like to donate to support the programme
My organisation would like to explore a partnership
I can help spread awareness in my network
How did you hear about the certification programme?
Additional comments or questions:
SECTION 9 — DECLARATION & CONSENT
I confirm that the information provided in this form is accurate to the best of my knowledge. I understand that certification is subject to verification by Nature Rwanda and that inaccurate information may result in withdrawal of certification. I consent to Nature Rwanda contacting me regarding this application and to my space being listed as a certified space on the Nature Rwanda website and communications materials.
*
I agree to the declaration above
Name
*
First Name
Last Name
Date (MM/DD/YYYY)
*
-
Month
-
Day
Year
Date
Signature
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