Neighborhood Engagement Form
The information you provide on this form is for exclusive use of NSCA staff, it will not be share with anybody outside the organization.
Street Address Line 2
State / Province
Postal / Zip Code
Please enter a valid phone number.
About the Problem or Issue
Problem or Issue Tittle
Problem or Issue Description
What is the location? (if applies)
For example: Sidewalk, Backyard, etc.
What is the problem or issue related to?
Developers (please call 911 if extreme and unable to wait for response)
City (please call 911 for emergencies/fires/major flooding)
Engagement (must uphold CDC/PA COVID-19 social distance standards and sign waivers)
The issue with the Developer is related to:
Damage of public spaces
Unacceptable public behavior
The issue with the City is related to:
Philadelphia Water Department
Philadelphia Gas Department
The issue with the Neighbors is related to:
Trash or Illegal Dumping
Unacceptable public Behavior
The issue with the NSCA is related to:
Issues with Organization/Event
Issue with Staff Member
Building issue (any damage or otherwise incurred to building that a resident notices)
The issue with the Engagement is related to:
Request a community calendar
Sign up for our email list/request help with our email list
Request specific information about event
Request community meeting
Request event space/use of building
Request information about Zoning
Question about our social channel
What type of space are you interested?
Use of meeting room
Use of computer room
Use of open spaces
Rent of tables and/or chairs
The Service Requested is related to:
Request assistance with City of Philadelphia paperwork
Request assistance with other paperwork
The Housing Request is related to:
I need housing counseling
I want to buy a home
I need to rent a home
I need low income housing
I am having problems with my landlord
I'm about to lose my rental (eviction)
I'm about to lose my home (foreclosure)
I need help paying my bills
I want to buy an empty lot
I need repairs in my home
Specifically, what related to COVID-19?
Where do I get tested?
I feel sick, what do I do?
Report unsafe events
I need more information
Drag and drop files here
Choose a file
Under 18 years
18 to 24 years
25 to 44 years
45 to 64 years
65 years and over
When was the person contacted?
Are we taking the case?
What was the outcome?
Do you have any other comment or concern?
Please allow 24 to 48 for a response.
Should be Empty: