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Adopt-A-Street Supply Request Form
The City of College Station thanks you for participating in the Adopt-A-Street Program. Please complete this form at least five business days before your scheduled cleanup.
  • Ensure all volunteers scheduled to participate are listed in Exhibit A, on file with the City.
  • Ensure all volunteers scheduled to participate have Exhibit B on file with the City.
  • Please collect the required safety vests, disposable gloves, trash bags, grabbers, and paperwork the business day BEFORE your scheduled cleanup from Room 237 on the 2nd floor of the Municipal Court Building, located at 300 Krenek Tap Rd.
  • Distribute safety vests, disposable gloves, trash bags, and grabbers to participating group members.
Subsequent to each cleanup:
  • Secure and place all used/filled trash bags at one sign location on your adopted street or segment of street for collection and disposal.
  • Return the safety vests, grabbers and any unused disposable gloves and trash bags on the NEXT business day.
  • Complete and submit a Cleanup Report Form online.
Group Affiliation:

Contact Name:

I am acting as or for the above named Group and acknowledge that I have reviewed and hereby accept the provisions of the City’s Adopt-A-Street Resolution (Number 09-21-88-06) including any amendments thereto, and agree to abide by the guidelines set therein, and to the terms of the ADOPT-A-STREET PROGRAM AGREEMENT to which I have affixed my signature and which will become effective upon approval by the City of College Station, Texas.
Yes
E-mail:

Phone:

Location of Cleanup:

Date of Cleanup:

Total Number of Volunteers Anticipated:

Additional Comments or Questions: