Agency/Organization Name

Agency Contact Name

Agency Contact Email

Agency Contact Phone

Project Name

Project Location/Address

Project Description

Estimated number of volunteers needed per project during the 4-hour period. (Please prepare 2 backup projects for each project submitted in case volunteers finish early. Where applicable, please also prepare an indoor project in the event of rain.)

Volunteers are scheduled in 4-hour blocks, M-F, from 8am-12 pm or 12-4pm. Please check all shifts your project could be completed.

Questions	Yes	No
5/8 - Monday 8-12	Yes	No
5/8 - Monday 12-4	Yes	No
5/9 - Tuesday 8-12	Yes	No
5/9 - Tuesday 12-4	Yes	No
5/10 - Wednesday 8-12	Yes	No
5/10 Wednesday 12-4	Yes	No
5/11 Thursday 8-12	Yes	No
5/11 Thursday 12-4	Yes	No
5/12 Friday 8-12	Yes	No
5/12 Friday 12-4	Yes	No

What skills does your project require? (Please check all that apply)

Cleaning/Organizing

Painting

Outdoor work/landscaping

General repairs/construction savvy

Heavy labor (Ex: chopping wood, moving furniture, etc.)

Other…

Enter other…

Does your project include any of the following?

Heavy lifting

Heights

Recommended Clothing

Questions or Comments

I have read the Days of Caring: Agency Guidelines (see hyperlink below)

- Select -Yes

Days of Caring: Agency Guidelines

 

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