Online Application for Community Service

Agency or Organization Name

Contact First and Last Name

Email Address

Address

City

State StateAlabamaAlaskaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip

Phone (Digits Only)

Website

What Day Would you like this Project Performed? What Day Would you like this Project Performed? Monday, January 15, 2018, MLK Day of Service Saturday, April 7, 2018, Global Youth Service Day Any Day Would Work

Up to $500 may be available for each project. What funding would be needed to complete this project? Up to $500 may be available for each project. What funding would be needed to complete this project? $0 $250 $500

Is this project dependent on the funding requested? Is this project dependent on the funding requested? Yes No

How will the funding be used?

Who will benefit from the project?

Project Location

Project Description

Will there be any preparation required before the date of the actual service? If yes, please describe

3 hours will be provided to complete the project (Assuming we provide approximately 20 hard working volunteers) What is the maximum number of volunteers you could accommodate?

Can someone be available to welcome the youth, to explain the mission of the organization and its programs and explain the project and the benefit that will result? Can someone be available to welcome the youth, to explain the mission of the organization and its programs and explain the project and the benefit that will result? Yes No

Can you commit to working with the Foundation to complete a joint press release after completion of the project? Can you commit to working with the Foundation to complete a joint press release after completion of the project? Yes No

Additional Comments?

Number