Hellbender Report Form

We are interested in receiving reports of Eastern Hellbenders from Pennsylvania or any other state. If you provide a report, you will receive an email response and you may be asked to provide additional details regarding your observations or directions to the location. Follow-up reports will be sent to you after we check the site to determined if Hellbender salamanders are still present and how many we find.

Please begin your report by entering your name, email address, and telephone number. (You can enter your mailing address in the observations window below if you have no email address.)

First Name	Last Name
Email Address	Phone Number with Area Code
	Phone Type

Please continue your report by entering once choice for each category.

State	Pennsylvania Watershed
Pennsylvania County	Habitat Type

Please continue your report by entering the requested information.

Observation Date (mm/dd/yyyy)	Stream Name (if known)
Nearest Village or Town	Nearest Road (if known)

Precise locality information is very useful. Visit this website (http://mapper.acme.com) and enter the name of the nearest town in the white entry field (e.g., Bellefonte, PA). Position the "+" at the observation location on the map and read the coordinates in the tan block at the top, then enter them here.

Latitude (indicated with an "N")

Longitude (indicated with a "W")

Please describe your observations in detail in the space below. Describe what you have observed, and where and when you made your observations. (Old reports are welcome even if you can't recall the exact date or location. We've received reports that were made more than 60 years ago!)

Form Revised 03/10/09