2. Organization/Neighborhood Name*
4. Contact Person*
5. Contact Person Email*
7. Complete Address
9. Phone Number*
11. Date - 1st Choice*
    -- Select One --April 15April 22April 29May 13May 20June 10June 24August 12August 26September 16September 23October 7
12. Date - 2nd Choice*
    -- Select One --April 15April 22April 29May 13May 20June 10June 24August 12August 26September 16September 23October 7
14. Reason for Request*
16. Will Neighborhood Residents Assist?*

    1. Yes
    2. No
17. If yes, approximately how many?
19. Areas to be Covered:*
21. Please Note:

    The BAN program is designed to be a PARTNERSHIP between the City and its neighborhood organizations. By definition, this requires a degree of participation by the individuals living in the neighborhoods and the organization requesting a BAN date.  Any scheduled BAN event WITHOUT participants from the neighborhood attending and participating in the clean-up will result in the event being cancelled. 

    If you have questions, contact Wendy Heslink at 330-438-4309 or wendy.heslink@cantonohio.gov. 

    After review of the application, the organization/individuals will be notified if approved or denied. 

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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit Submit and Print

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