State Farm Neighborhood Assist ® 2018

About You

Before we can help you submit your cause, we need to know a little bit about you. Please fill out this form so we can contact you if your cause is selected as a finalist. Don't worry, you'll have a chance to review this information before you submit it. All fields are required. Need help? Click on the info tip icons below.

 
Your information will be used only for purposes of voting in the State Farm Neighborhood Assist Program. State Farm will not use your information for marketing purposes.