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Adopt-A-Street Supply Request
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.
  • The pickup of the required safety vests, disposable gloves, trash bags, grabbers and paperwork will be SCHEDULED upon the completion and review of this form.
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 SCHEDULED business day.
  • Complete and submit a Cleanup Report Form online.
Be completing this form, I am acting as or for the below 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.
Group Affiliation:

Primary Contact Name:

E-mail:

Phone:

Secondary Contact Name:

Secondary E-mail:

Secondary Phone:

Location of Cleanup:

Date of Cleanup:

Total Number of Volunteers Anticipated:

Additional Comments or Questions: