2010 Agency Application

							                           UNITED WAY OF GREATER ST. LOUIS
                                    Volunteer Center


                         2010 Days of Caring/St. Louis Cares
                           Agency Project Application
Please submit a separate form for each project. Print or type.

_______________________________________________________________________________________
Agency Name

_______________________________________________________________________________________
Address*                   City                 State                Zip

_______________________________________________________________________________________
Agency Project Coordinator                      Title

_______________________________________________________________________________________
Coordinator Phone                 Fax                         Email address

Is the location accessible for people with disabilities?         Yes       No

Will the project take place at the address listed above? Yes      No
         If no, where?*_____________________________________________________________________

                      ______________________________________________________________________


Type of project (check one) Please note that Days of Caring Projects can NOT be fund-raising related

    General yard work/landscaping                       Painting/general
    Activities with children or youth                   Cleaning/sorting
    Activities with adults                              Activities with the elderly
    Administrative/office work                          Food/school supplies drive
    Activities with persons with disabilities
    Other (please specify)________________________________________________________________

    This project is family friendly (minimum age of children who can volunteer:__________________)

Description of the project
Important: Please describe in detail!

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________

_______________________________________________________________________________________




12/31/2012                                           1     519e6ab4-86e6-437d-8f47-fcc407ed7378.doc
Preferred project date and time

List the month(s) that this project can be conducted: _____________________________________________

    Project is an on-going activity (any month is available for agency to receive volunteers for this project)

    We can host a “Servathon-style” project in 2009 co-branded with United Way (large-scale projects such as a
playground build, fitness fair for youth, large-scale painting/cleaning/yard work project, etc where 30-200
volunteers would be working together as a group).

Preferred Day of week
   Weekday                         Weekend                             No Preference
*Times may be adjusted based on company and agency requests

Time*
   Half day-A.M. (9:00 a.m. - 12:00 noon)                 Half day-P.M. (1:00 p.m. - 4:00 p.m.)
   Evening hours (4:00 p.m. - 8:00 p.m.)                  Full day (9:00 a.m. - 4:00 p.m.)
   No Preference
*Times may be adjusted based on company and agency requests

Do you have a specific date that the project must take place?       Yes; when?____________________          No

Project location
Check State and County where the project will take place

   Missouri                         Franklin                   St. Charles             Warren
                                    Jefferson                  St. Louis City
                                    Lincoln                    St. Louis County

   Illinois                         Clinton                    Monroe                  St. Clair
                                    Madison                    Randolph                Greene
                                    Calhoun                    Macoupin                Jersey

Number of volunteers needed for the project

   3-5           6-10             11-15           16-20            21-25
   26-30         31-40            41-50            *Over 50; please specify__________________
* The United Way receives several requests from companies/groups with 50+ participants from time to time

Materials required for the project (to be supplied by the agency)

_______________________________________________________________________________________

_______________________________________________________________________________________

Special skills needed for the project

_______________________________________________________________________________________

_______________________________________________________________________________________
Fax or mail completed form to: Rick Skinner, Vice President
        Volunteer Center                                                DOC
                               United Way of Greater St. Louis          SLC
                                         th
                               910 N. 11 Street                         ________
                               St. Louis, MO 63101
                               Fax number: (314) 539-4154           Volunteer Center Use only
                               Phone number: (314) 539-4284


12/31/2012                                       2         519e6ab4-86e6-437d-8f47-fcc407ed7378.doc