Individuals Heroes in the Hood Application Survey

1. Please provide us with the following information:

Please provide us with the following information: Name:
E-mail Address:
Home Address:
Address 2:
City/Town:
State/Province:
ZIP Code:
Phone:
Email Address:

2. Parents/Guardians Contact Information:

Parents/Guardians Contact Information: Parents/Gardians Name:
Parents/Gardian Phone:

3. Age

Age

4. Grade

Grade

5. In which city ward do you live? (If you're not sure, click here to view the ward maps.)

In which city ward do you live? (If you're not sure, click here to view the ward maps.) Ward 1 - Alderman Joe Proco Moreno

Ward 2 - Alderman Robert Fioretti

Ward 3 - Alderman Pat Dowell

Ward 4 - Alderman William D. Burns

Ward 5 - Alderman Leslie Hairston

Ward 6 - Alderman Roderick T. Sawyer

Ward 7 - Alderman Sandi Jackson

Ward 8 - Alderman Michelle Harris

Ward 9 - Alderman Anthony Beale

Ward 10 - Alderman John Pope

Ward 11 - Alderman James Balcer

Ward 12 - Alderman George A. Cardenas

Ward 13 - Alderman Marty Quinn

Ward 14 - Alderman Ed Burke

Ward 15 - Alderman Toni Foulkes

Ward 16 - Alderman Joann Thompson

Ward 17 - Alderman Latasha Thomas

Ward 18 - Alderman Lona Lane

Ward 19 - Alderman Matthew J. Oshea

Ward 20 - Alderman Willie Cochran

Ward 21 - Alderman Howard Brookins Jr.

Ward 22 - Alderman Ricardo Munoz

Ward 23 - Alderman Michael Zalewski

Ward 24 - Alderman Michael D. Chandler

Ward 25 - Alderman Daniel Solis

Ward 26 - Alderman Roberto Maldonado

Ward 27 - Alderman Walter Burnett, Jr.

Ward 28 - Alderman Jason C. Ervin

Ward 29 - Alderman Deborah L. Graham

Ward 30 - Alderman Ariel E. Reboyras

Ward 31 - Alderman Ray Suarez

Ward 32 - Alderman Scott Waguespack

Ward 33 - Alderman Richard F. Mell

Ward 34 - Alderman Carrie Austin

Ward 35 - Alderman Rey Colon

Ward 36 - Alderman Nicholas Sposato

Ward 37 - Alderman Emma Mitts

Ward 38 - Alderman Timothy M. Cullerton

Ward 39 - Alderman Margaret Laurino

Ward 40 - Alderman Patrick J. O'Connor

Ward 41 - Alderman Mary O'Connor

Ward 42 - Alderman Brendan Reilly

Ward 43 - Alderman Michele Smith

Ward 44 - Alderman Thomas M. Tunney

Ward 45 - Alderman John Arena

Ward 46 - Alderman James Cappleman

Ward 47 - Alderman Ameya Pawar

Ward 48 - Alderman Harry Osterman

Ward 49 - Alderman Joseph A. Moore

Ward 50 - Debra L. Silverstein

6. Please fill out the following information about your school.

Please fill out the following information about your school. School Name:
Address:
City/Town:
State/Province:
ZIP Code:
School Phone:
Principal:

7. Please provide a detailed description of your service or project.
What did you do?
Whom did you help?
Why did you do it?
What were the results?

Please provide a detailed description of your service or project. What did you do? Whom did you help? Why did you do it? What were the results?

Contest Rules:

1. You must be 12 — 18 years of age.

2. Service or project must have been performed in 2011

3. You must be a Chicago resident. Deadline: Entries must be returned by March 7, 2012.

Contest Sponsors:

GO Airport Express

Chicago Crusader

Dominick's

DuSable Museum of African American History Chicago White Sox WVON-AM

Individuals Heroes in the Hood Application