Form Center

2. Citizens making a difference in their community-
   The City of Cocoa understands that this is a stressful time as we navigate through this global health crisis. All of our employees are hard at work to ensure a continuation of core municipal services, with no interruptions in utilities, public safety, and all city maintenance and upkeep. Have you noticed a Cocoa resident that you felt is going above and beyond during this health crisis? Someone that has gone out of their way to ensure that the needs of our community are met. Tell us about out them! It is important to recognize the hard work that all of our residents are putting in during this time. Please help us recognize any Cocoa resident who has made your life better today!
4. Name of resident that you are recommending?
   If you don't know their full name or any part of it, please feel free to describe when and where you saw them going "above and beyond"
6. First Name
7. Last Name
9. If you don't know their name- feel free to tell us a few descriptors
11. Bragging rights! What did they do? How do you feel extra supported during this stressful time?
    Bragging rights! Have no shame! We are eager to hear all the great things that are happening! So tell us, why are you recommending this resident? Perhaps, in light of COVID 19 they have done something outstanding in the community that shows their commitment to the City. The more descriptive you can be, the more it helps paint a picture for the rest of us!
13. If you were able to snap a photo of them, feel free to upload it here!
    The more fun the photo, the better!
15. Please check us out on Facebook!
    City of Cocoa Government

    The residents we select will be featured on our social media pages for their contributions, so keep an eye out and be sure to tag them in each post.
Leave This Blank:


17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

* indicates a required field