Online Application for Community Service Agency or Organization Name Contact Name Contact Title Email Address City State ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Phone Website (Example: http://www.rrcommunityfoundation.org) What day would you like for this project to be performed? Monday, January 16, 2017, MLK Day of ServiceSaturday, April 15, 2017, Global Youth Service DayEither day would work Up to $1,000 may be available for each project. What funding would be needed to complete this project? $0$250$500$750$1,000 Is this project dependent on the funding requested? In other words, must you have the funding requested above to complete this project? YesNo How will the funding be used? Who will benefit from this project? Project Location Project Description (What will the Changemaker Youth be doing for you?) Will there be any preparation required before the date of the actual service? If yes, please describe Number of hours needed to complete the project (Assuming we provide approximately 30 hard working volunteers) What is the maximum number of volunteers you could accommodate? How would you like the volunteers to work? ShiftsAll at one timeOther If other (Please specify) 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? YesNo Can you commit to working with the Foundation to complete a joint press release after completion of the project? YesNo Questions or additional comments? Captcha
