PROGRAMS

GREAT INDY CLEANUP REQUEST FORM (MAY THROUGH OCTOBER)

Neighborhood Organization/Group *

Clean-Up Date Requested (May through October weekends) *

2nd Choice *

3rd Choice *

North Boundary of Cleanup Area *

South Boundary of Cleanup Area *

East Boundary of Cleanup Area *

West Boundary of Cleanup Area *

Number of Adult Volunteers Expected? *

Number of Youth Volunteers? *

What time does your community cleanup begin? *

Contact Person: *

First Name

Last Name

Address: *

Street Address
Address 2
City	State	Zip

Email Address: *

Day Phone Number: *

()

Cell Phone Number: *

()

Dumpster Placement - EXACT address and location for the dumpster to be placed. Please provide as much detail as possible (if no dumpster is needed please enter NONE): *

By submitting this request, I understand that the dumpster provided is NOT FOR PERSONAL USE (cleaning out garages, basements, etc.), but is a donated resource intended for cleanup of PUBLIC SPACES ONLY. I understand that these resources are for communities needing assistance with excessive litter and illegal dumpsite cleanups only and cannot be used for privately owned common spaces.