PROPOSAL FOR STREAM ADOPTION


     Please fill out this questionnaire as completely as possible and return it to
     the address below.  The information you provide will be used to send you
     appropriate materials and information, and in planning for the Stream Watch
     program.

     Keep in mind that all sizes of streams, rivers, lakes, and estuaries are 
     eligible for adoption.  If you're not sure which one to pick, we can make 
     some suggestions.

     If you have any questions, please contact David Wojnowski at 
     (919) 733-4064, or write:

                    Stream Watch Coordinator
                    Division of Water Resources
                    Dept of Environment and Natural Resources
                    1611 Mail Service Center
                    Raleigh, NC   27699-1611

Date: ___________________

1. Name you wish to call your group or organization:

   ____________________________________________________________

2. Mailing Address for all Stream Watch correspondence:

   ____________________________________________________________

3. Contact Person:_____________________________________

     Phone Numbers: (H)____/_____________(W)____/____________

   Secondary Contact:

     Phone Numbers: (H)____/_____________(W)____/____________

4. Describe the location of the water body to be adopted.  Use bridges, roads, towns,
   or confluences with other bodies of water to define the upstream and downstream
   limits of your segment.  (This is for our benefit, and you should not feel
   constrained by what you put down.)  Please mark its location on the smaller river
   basin map enclosed and return the map with this form.

   Water Body:_______________________________________________

   County(s):________________________________________________

   Upstream Limit:___________________________________________

   Downstream Limit:_________________________________________


5.  River basin in which your adopted water body is located:

    _____________________________

6. What features of your adopted stream (both positive and
   negative) have sparked your interest in forming a Stream Watch group?









7. Describe any ongoing or planned activities for your group:









8. What information and kinds of assistance would be helpful to your group?








9. In the future, may other individuals interested in joining Stream Watch contact
   your group?



10. How did you hear about the Stream Watch program?