Overview and Form Instructions

Formal and informal educators who participate in litter prevention education supporting the Clean California Campaign can apply for a $150 cash incentive to support youth participation in the K-12 Multimedia Contest, campus cleanups, litter lessons, or cleanup activities. To be eligible for the stipend, you must conduct litter prevention activities for K-12 youth. The Clean California website https://cleanca.com/education/ has resources, including supplemental lessons/activities, campus cleanup instructions with data cards, and the K-12 Multi-Media Contest information. Please take 10 minutes to complete the incentive request form and submit a photograph or supporting information. Keep California Beautiful will review your submittal and notify you if you have any questions or need your approval.

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* 1. Contact Information

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* 2. Type of educator:

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* 3. Participation Format:

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* 4. Grade Level (click all applicable)

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* 5. What was the source of the litter education materials? (Mark all applicable)

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* 6. Briefly describe the activities or lessons focused on litter prevention:

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* 7. Number of youth:

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* 8. Date of lesson or activity conducted:

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* 9. Did the youth participate in a litter assessment or cleanup?

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* 10. If you conducted a litter assessment or cleanup, what was the most commonly found item?

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* 11. What was the cleanest and most littered area?

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* 12. Please upload at least one supporting document, such as a photograph or copy of the lesson.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 13. Do you plan to encourage youth to submit an entry in the Clean California K-12 Multi-Media Contest due on January 31, 2025 (https://cleanca.com/education/)?

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* 14. How will you use the stipend to support your litter prevention education activities?

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* 15. By submitting an incentive application, you are confirming that you conducted litter prevention education with K-12 age youth and provide documentation to support educational activities and will use the $150 stipend to support your litter prevention education activities. Type First and Last Name to serve as your signature on this affirmation.

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