Nominate Your Block

Do the neighbors of your block deserve a positive and productive day of cleaning and playing to help kick off the spring season?! Do the kids on your block need a productive and safe outlet, led by dedicated volunteers?! If so, use this form to nominate YOUR block to be a part of The Block Gives Back, The Block Goes Green!

Disclaimer: Not knowing or answering “no” to any of these questions does not disqualify you and your block from participating in 4 Blocks in 4 Weeks. All information is considered when choosing blocks.

Name of Nominator:*

First NameLast Name

Name of Block (include which hundred block):*

ex: 6800 Springfield Street

Does this block have a block captain? If yes, who?:

First NameLast Name

Nominator Email*

Please provide a contact email address

Nominator Phone

Please enter a valid phone numberFormat: (000) 000-0000.

Do you live on this block?

YesNo

If not, do you know someone that does?

YesNo

Is there a reliable place we can plug in an extension cord)? Ex: can we use an outlet from the nominees house?

YesNoI'm not sure

Is there readily available bathrooms?

YesNoI'm not sure

Is there a significant amount of youth that live on this block?

YesNoI'm not sure

If yes, approximately how many kids?

Are there any abandon lots?

YesNoI'm not sure

Give a brief reason why you think your block deserves to be apart of 4 Blocks in 4 Weeks?

Any additional info you may feel if valuable

NOMINATE YOUR BLOCK!