diff --git a/.github/ISSUE_TEMPLATE/unblock-request.yml b/.github/ISSUE_TEMPLATE/unblock-request.yml
new file mode 100644
index 0000000..f0945d6
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+++ b/.github/ISSUE_TEMPLATE/unblock-request.yml
@@ -0,0 +1,28 @@
+name: Allow a domain or sub-domain to be unblocked
+description: Submit a request for blocked domain or sub-domain/s to be removed from a blocklist
+labels: ["unblock-request"]
+assignees: 
+  - systemjargon
+body:
+  - type: textarea
+    id: blocklists
+    attributes:
+      label: Which blocklist are you using?
+    validations:
+      required: true
+
+  - type: textarea
+    id: domains
+    attributes:
+      label: Which domain/s or sub-domain/s should be un-blocked?
+    validations:
+      required: true
+  
+  - type: textarea
+    id: reason
+    attributes:
+      label: Why should the domain/s or sub-domain/s be unblocked?
+      description: |
+        What happens if this is not blocked? What functions do not work for a domain or site? Feel free to add a screenshot.
+    validations:
+      required: true