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Make A Difference Day Results Form

 

After completing your cleanup, please send the results to us. We will then compile the results and send them to local media and Keep America Beautiful. If you see an activity listed that you did not do during your cleanup day, just leave that space blank. We understand that there are activities not completed by everyone. Also, do not be afraid to estimate a number if you do not have an exact count. We understand that a lot of numbers are estimates, but an estimate is better than no number at all! Your numbers enable us to compile our local results and send those to Keep America Beautiful. Those total national results tell the factual story of our network and about all of your hard work and achievements during Make a Difference Day 2009!

Community/Neighborhood:

County: State:

Group or Organization Name:

Contact Name:

Mailing Address (one that is checked daily):

City,State,Zip:

Phone (home):

Phone (work):

E-mail Address:

Specific Location of Cleanup Site(s):

Date of Cleanup:

Number of Volunteers: Number of men: Number of women: Number of young adults: (under age 18): Total number of volunteer hours: (number of volunteers times the amount of time theyworked; example: 30 people times 3 hoursis 90 volunteer hours): Number of garbage bags collected: Pounds of unbagged litter or debris: Please specify (example: 2 refrigerators): Miles of streets cleaned: Miles of highway ramps cleaned: Miles along railroad tracks cleaned: Acres of parks cleaned: School playgrounds cleaned: Miles of hiking/biking/nature trails cleaned: Illegal dumps removed: Junk cars removed: Bags of aluminum/steel recycled: Bags of office paper recycled: Number of tires collected: Batteries recycled: Trees planted: Flowers planted: Bulbs planted: Park/rec./playground Residential structures painted: Commercial structures painted: Graffiti removal sites:

Please describe your most creative and/or unusual activity/program:

Please describe the activity that had the most impact on your community:

Please describe any support, funding, supplies, or in-kind donations that you leveraged, in addition to what was offered by Keep Cincinnati Beautiful:

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