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Community Partnership Program (CPP)

A Partnership to clean vacant lots, playgrounds, parks and streets.

Instructions: Fill out all of the information correctly. Be sure to fill in the number of each item requested. This form must be received at least one week prior to the clean up date. Supplies are to be picked up at our warehouse located at 4000 N. American Street (entrance on Luzerne St.) MAP. All equipment must be returned no later than the following Wednesday after the pick up date. Pick up and drop off times are Wednesday - Friday between 9:00 a.m. and 1:00 p.m. A valid ID with address must be presented before the supplies can be taken from the warehouse. If you have any questions, please contact (215) 685-9558.
* indicates required fields

A PDF version of this form is also available here 

311 Tracking Number
(for staff use only)

A. Organization Information
Organization Name
Zip Code*
# of Volunteers for Clean Up
Phone Number (home)*
Work Number
Fax Number
Email Address*
Date of Clean-Up*
B. List of Supplies & Equipment Requested
Bow Rakes Leaf Rakes Square Shovels
Brooms Digging Shovels Bags
C. Sanitation Pick Up Site/s - Sanitation pick up for this cleanup is available and is coordinated by CPP. The form for this service must be signed in person with the CPP coordinator. Trash must be dropped off at the nearest intersection to the clean-up site/s. Please note that City crews assigned to collect this bagged trash operate from 9:00 a.m. - 1:00 p.m. on Saturdays. Separate arrangements need to be made for bulk items, concrete and hazardous waste. Do not overfill trash bags with debris because they may break open. (*please include zip code)
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I understand that the above equipment and supplies are only a loan and I agree to return the above mentioned in the same condition as I received them. If this equipment is lost or stolen, I (or my organization) will immediately provide the Community Partnership Program with the same new equipment to replace what is missing.
Pick Up date: Return Date:
 Received by:  Received by:
 CPP Staff:  CPP Staff: