Applicant Information
Name of Organization or Group *
What Type of Adoption Are You Applying For? * Volunteer AdoptionSponsored Adoption
Have you previously adopted or sponsored a channel? * YesNo
Contractor Information
Please only fill out this section if you are applying for a channel sponsorship.
Name of Chosen Contractor
Are you a contractor applying on behalf of the sponsoring organization? YesNo
Channel Site Information
Please provide information regarding your requested channel adoption below.
Requested Channel Segment *
Click Here to View Available Channels.
Participation in the Adopt a Channel program involves performing scheduled litter removal twice annually. Is your organization/group/company able to commit to this level of participation? * YesNo
Adopters can also elect to perform graffiti removal in their chosen channel in addition to performing litter removal services. Please indicate below if you are interested in performing graffiti removal in your chosen channel? * YesNo
Program Recognition Panel
Please provide the name of your organization/group you would like featured on your recognition panel: *
If you have a logo, please attach a JPEG file below:
Primary Contact Information
Primary Contact Name *
Primary Contact Address *
State *
ZIP Code *
Primary Email Address *
Primary Phone Number *
Secondary Contact Information
Secondary Contact Name *
Secondary Contact Address *
Secondary Email Address *
Secondary Phone Number *
Please leave this field empty.
