Agency Name

Project Address

City

State

Zip

Contact Person

Phone

e-mail

Date of Project(s)

Please complete a Project Description for each project your agency will host. If hosting more than 1 project, you may make copies and attach additional sheets from the downloadable pdf form from above.
Agencies are required to furnish all materials necessary to complete the project. All projects submitted will be examined before final approval. You will be notified by United Way about which projects have been approved and of your corporate match(es).

Date of Project

Address of project site
(if different)

Contact for this project
(if different)

Number of volunteers required

Start Time of Project

Approx. Time for completion

Description: