“Community Roots” Local History Form
for an individual, neighborhood, organization or business

Neighborhood, Organization, Business Information

Group Name _____________________________________________________________

Address_________________________________________________________________

Phone # ____________________________  FAX _______________________________

Email ______________________________ Web Site____________________________

Group Contact Person or Individual Person Information

Name __________________________________________________________________

Address_________________________________________________________________

Phone # ____________________________  FAX _______________________________

Email ______________________________ Web Site____________________________

1.         Give a brief description of your current neighborhood, group or organization.  For example: mission, officers, activities, membership, etc.

2.          What is the date / approximate date of your neighborhood or group’s founding?

3.         Give a brief description of how your neighborhood was established or how and why your group was founded.  You may wish to include the names of any persons who would be resources for historical information as well as the names of the originators or initial group officers.

4.         Highlight any important events or happenings.

5.         Any additional comments.

Please Mail this form and additional pages to:

PAC/VBHS “Community Roots” Project
c/o Upper Wolfsnare
2040 Potters Road
Virginia Beach, VA  23454        FAX to:  757-467-5047.