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2. 
3. 
5. Organization/Group Name or Individual*
7. Primary Contact Name*
9. Contact Email*
11. Phone Number*
13. Date of Cleanup*
    Date of Cleanup
15. Cleanup Location*
17. Number of Volunteers/Participants*
19. Length of Cleanup (hours)*
21. Litter Ranking*

    Please tell us how littered the location was BEFORE the cleanup.

    1. Clean
    2. Slightly Littered
    3. Littered
    4. Heavily Littered
23. Total Number of TRASH BAGS Collected*
25. Total Number of RECYCLING BAGS Collected*
27. HELP US IMPROVE OUR PROGRAM BY EVALUATING YOUR CLEANUP EXPERIENCE!
29. Supplies received were sufficient for my event.
    -- Select One --Strongly DisagreeDisagreeAgreeStrongly Agree
31. The area matched the capabilities of my group.
    -- Select One --Strongly DisagreeDisagreeAgreeStrongly Agree
33. My group could see a positive impact we had on the cleanup area.
    -- Select One --Strongly DisagreeDisagreeAgreeStrongly Agree
35. The provided map/directions assisted my group during the cleanup.
    -- Select One --Strongly DisagreeDisagreeAgreeStrongly Agree
37. Cleanup Program Notes or Suggestions:
39. We would love to tag your efforts on our social media! Please paste the links to your Facebook, Instagram, and/or Twitter pages below.
41. Facebook:
43. Instagram:
45. Twitter:
47. Please share any pictures of your cleanup with KMB!
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

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