Please fill out this report as soon as your project is completed while the information is fresh in your mind. You must submit this form to the KLLCB office before your money can be dispersed to you. Remember to include photographs.

Name of Organization:		Contact Person:
Address:		Phone (home):	Phone (work):
Location Cleaned Up:		Total Number of People Who Participated (including planning):
How many people hours were spent on planning, organizing and implementation of project. If 10 people volunteered 2 hours each and 2 people volunteered 15 hours each, this is a total of 50 people hours - (10x2)+(2x15)=50. Include all time you spent no matter how trivial it may seem. Total Volunteer Hours:

Size of cleanup area or length of street: Blocks Miles
How much was picked up (including recyclable): Bags Pounds
How much was recycled? Fill in amount and circle how it was measured. Use a 30 gal. (trash can) bag for measuring. Use your best estimate.
Aluminum: Bags Pounds	Glass: Bags Pounds
Scrap Metal: Bags Pounds	Appliances:
Paper: Bags Pounds	Batteries:
Plastic (Soda/Milk): Bags Pounds	Tires Recycled: Tires Pounds
Brush Composted/Mulched: Rolloffs Pounds	Other (Specify):

List the names of any other organization(s) involved (if any):

List any In-Kind contributions or donations made to this project (meals, refreshments, tools, vehicles, fliers, gas etc.) This part is extremely important. Be as thorough as possible.
What was donated?	What is it worth?
	$
	$
	$
	$

Brief Description of completed project. Include before, during and after photographs.

Brief description for what the mini-grant money was/will be user for:

Additional Comments:

Do you feel the project was worthwhile? Why?

What changes in guidelines would you like to see if we continue this project next year?

How can the Keep Lincoln & Lancaster County Beautiful Program better server your community in future projects?

Ideas and Suggestions:

**Photographs must be included in order to receive KLLCB Clean-up Mini-grant**
Please send pictures to:
Keep Lincoln & Lancaster County Beautiful Program
3140 N Street
Lincoln, NE 68510

Or e-mail pictures to:
hheafer@lincoln.ne.gov

Questions? Please call Harry Heafer at 441-8035