Part I. Garden, Program, and Contact Information
Name of Group or Individual
Country
Albania Algeria American Samoa Angola Anguilla Antigua Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Bosnia Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Chad Chile China Colombia Congo Cook Islands Costa Rica Croatia Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Grenada Guadeloupe Guam Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Ireland (Republic of) Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kosovo Kosrae Island Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Moldova Mongolia Montserrat Morocco Mozambique Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Ponape Portugal Puerto Rico Qatar Reunion Romania Rota Russia Rwanda Saipan Saudi Arabia Senegal Serbia and Montenegro Seychelles Singapore Slovakia Slovenia Solomon Islands South Africa South Korea Spain Sri Lanka St. Barthelemy St. Croix St. Eustatius St. John St. Kitts and Nevis St. Lucia St. Maarten St. Thomas St. Vincent and the Grenadines Suriname Swaziland Sweden Switzerland Syria Tadjikistan Taiwan Tanzania Thailand Tinian Togo Tonga Tortola Trinidad and Tobago Truk Tunisia Turkey Turkmenistan Turks and Caicos Tuvalu Uganda Ukraine Union Island United Arab Emirates United Kingdom United States Uruguay US Virgin Islands Uzbekistan Vanuatu Venezuela Vietnam Virgin Gorda Wallis and Futuna Western Samoa Yap Yemen Zambia Zimbabwe
Address where you started walk around neighborhood (include street and number if available, or nearest cross streets if number not known).
Address (additional line, if necessary)
City	State	Zip Code
	Select State ................. Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Name of Youth Program or Other Program (Optional)
Name of Adult Contact
Email Address of Adult Contact
Check here if you do NOT want your email address      posted with your Neighborhood Exploration Form on our website
Date of walk:
Select a Month .............. January February March April May June July August September October November December Select a Day .............. 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Select a Year ............. 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Number of participants involved in Neighborhood Exploration:
Youth
Gardeners
Adult Educators/Volunteers
Part II. Neighborhood Exploration Report
1. Total Distance walked:
0 - ¼ ¼ - ½ ½ - ¾ ¾ - 1 1 - 2 More than 2 Miles Kilometers
2. Did you find places where people can (attach some photos of these places):
Get fresh food Talk with friends Enjoy nature Relax and play games Get exercise See concerts, plays and other cultural events Learn new things Hold community events Plant Trees Create a park or garden Other
3. Did you find any (attach some photos of these features):
Vacant lots Community gardens School gardens Home gardens Parks Food stores or markets Schools Concert halls Libraries Community centers Single family homes Apartment buildings Other
4. Write a short essay about what you learned on your Neighborhood Exploration. What did you observe? What could you do to improve the neighborhood?
5. Photographs (Optional) Please attach several digital photographs for display with your Neighborhood Exploration.. See the guidelines for submitting photographs. Print photographs may be mailed to the address below.
Photo #1 Caption Photo #2 Caption Photo #3 Caption Photo #4 Caption Photo #5 Caption Photo #6 Caption
If you cannot submit the form via the web, you may send it as an attached file to gardenmosaics@cornell.edu. Or you may mail the printer-friendly version of the form to: Garden Mosaics Department of Natural Resources Fernow Hall 16 Cornell University Ithaca, NY 14853

Garden Mosaics is funded by the National Science Foundation Informal Science Education Program (ESI 0125582), and NYS College of Agriculture and Life Sciences at Cornell University.