Pick-Up Iowa Reporting Form for Reimbursement

Please complete the form below to report on your Pick-Up Iowa event and receive reimbursement for your purchases.

Pick-Up Iowa Reporting with Reimbursement

Point of Contact Information
Name*
First Last
Email*
Address for Reimbursement Check*
Street Address Address Line 2 City State ZIP Code
Project Information
City/Town Name*
County*
Name of Organization
If your Pick-Up Iowa event was associated with a specific group or organization, please include the organization or group name.
Date of Pick-Up Event*
MM slash DD slash YYYY
How many volunteers participated?*
If you are unsure, please provide your best estimate.
How many total hours did volunteers contribute to the project?*
If you are unsure, please provide your best estimate.
How many trash bags did you fill?*
If you are unsure, please provide your best estimate.
What type of location did you clean up?*
Examples: road, street, lake, pond area, park, school, neighborhood, cemetery, etc.
Any additional information you'd like to provide about your event?
Photos
If you took photographs of your event and are willing to share them with Keep Iowa Beautiful, please upload them here.
If you took photographs of your event and are willing to share them with Keep Iowa Beautiful, please upload them here.
Drop files here or

Max. file size: 128 MB.
Social Media Links
We’d like to share your Pick-Up Iowa event success on Keep Iowa Beautiful social media. Please provide any applicable handles so we can promote your event.
Facebook
Twitter
Instagram
Reimbursement Information
Please provide the information below to receive your reimbursement. As a reminder, reimbursable expenses may include pick-up supplies (i.e. trash bags, gloves, trash grabbers, etc.) and volunteer incentives (i.e. food, non-alcoholic beverages, etc.).
Please list items purchased*
Please upload a copy of your receipt*
Drop files here or

Max. file size: 128 MB.

Pick-Up Iowa Reporting Form for Reimbursement

Pick-Up Iowa Reporting with Reimbursement

Point of Contact Information

Project Information

Photos

Social Media Links

Reimbursement Information

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