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)

Please describe your observations in detail in the space below. Describe what you have observed, and where and when you made your observations. (Good locality information is essential for us to revisit the site to confirm if hellbenders are still present. Old reports are welcome even if you can't recall the exact date or location.)

Form Revised 04/10/2007