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? 2 + 4 = Submit Request
