promo
Submit Your Entry

My Information
Name:

Invalid Input
Address:

Invalid Input
City:

Invalid Input
State:

Invalid Input
Zip:

Invalid Input
Phone:

Invalid Input
E-mail Address:

Invalid Input
Resident since:

Invalid Input

Title
Please indicate the name of the Title sponsor you visited.
Title Sponsor:

Invalid Input
Date:

Invalid Input

Parks
Please indicate the Parks you visitied.
Community Park:

Invalid Input
Neighborhood Park 1:

Invalid Input
Neighborhood Park 2:

Invalid Input
Date:

Invalid Input
Date:

Invalid Input
Date:

Invalid Input

Recreational
Please indicate the Recreational place you visited.
Place:

Invalid Input
Date:

Invalid Input

Environmental
Please indicate the Environmental sites you visited.
Site 1:

Invalid Input
Site 2:

Invalid Input
Date:

Invalid Input
Date:

Invalid Input

Historical
Please indicate the Historical place you visited.
Place:

Invalid Input
Date:

Invalid Input

Multicultural
Please indicate the Multicultural place you visited.
Place:

Invalid Input
Date:

Invalid Input

Educational
Please indicate the Educational locations you visited.
Elementary School:

Invalid Input
Middle School:

Invalid Input
High School:

Invalid Input
Date:

Invalid Input
Date:

Invalid Input
Date:

Invalid Input

Only in Coral Springs
Please indicate the place you visited.
Place:

Invalid Input
Date:

Invalid Input

Governmental
Please indicated the facilities you visited.
Facility:

Invalid Input
Fire Station:

Invalid Input
Date:

Invalid Input
Date:

Invalid Input

Public Art
Please indicate the art pieces you visited.
Art Piece 1:

Invalid Input
Art Piece 2:

Invalid Input
Date:

Invalid Input
Date:

Invalid Input

Events and Activities
Please indicate the events or activities in which you participated.
Event/Activity 1:

Invalid Input
Event/Activity 2:

Invalid Input
Date:

Invalid Input
Date:

Invalid Input

Do you require services hours for this civic engagement project?
Service hours?

Invalid Input

Essay
Please enter your 200 word essay here:
Essay

Invalid Input

Photos
Please upload your 3 photos (one of you at City Hall, one in a park and one of your choice) here:
Photo 1:

Invalid Input
Photo 2:

Invalid Input
Photo 3:

Invalid Input
Please type the letters you see:
Please type the letters you see:
Refresh
Invalid Input