Worksite Project Request Form

Worksite Project Request Form
- Your Organization's Name*
- One Sentence Description of What Your Organization Does
- Your Name*
  
  First NameLast Name
- Your Title
- Your Email Address*
  example@example.com
- Your Phone Number: Office*
  Format: 000.000.0000.
- Your Phone Number: Mobile*
  Format: 000.000.0000.
- Yes, I will.No, someone else will be the day-of supervisor.
- Provide the name and mobile phone number of the worksite supervisor, if someone other than you.
- Who will be the Onsite Supervisor (person welcoming and supervising volunteers?*
  
  First NameLast Name
- Onsite Supervisor's Title
- Onsite Supervisor's Email*
  example@example.com
- Onsite Supervisor's Phone: Office
  Format: 000.000.0000.
- Onsite Supervisor's Phone: Mobile*
  Format: 000.000.0000.
- Monday, June 24, 1:00 - 4:30 PMTuesday, June 25, 10:00 - 12:30 PMTuesday, June 25, 1:00 - 4:30 PMWednesday, June 26, 10:00 - 12:30 PMWednesday, June 26, 1:00 - 4:30 PMMonday, July 15, 1:00 - 5:00 PMTuesday, July 16, 1:00 - 5:00 PMWednesday, July 17, 1:00 - 5:00 PM
- If you are interested in hosting a team at times that do not align with these scheduled times, please do not hesitate to reach out to us and we will do our best to accommodate your request.
- Up to 10 peopleUp to 15 people
- Outdoor Service Projects: What service projects do you have that students could complete at your organization, while remaining outside. Please list all outdoor service projects you would like completed and approximately how long it would take a group of 10 participants to complete each project.*
  (If you do not have any outdoor projects please write n/a.)
- Indoor Service Projects: What service projects do you have that students could complete at your organization, indoors. Please list all indoor service projects you would like completed and approximately how long it would take a group of 10 participants to complete each project.*
  (If you do not have any indoor projects please write n/a.)
- Service Project Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Special Instructions: Location and Connecting that Day
- What supplies are needed for these service projects, and where are these supplies located at your organization?*
- Your organization is responsible for providing all supplies and covering all costs for the service projects, unless a specific request is made to and approved by our Program Director. If you are requesting THP to provide any supplies or cover any costs, please list these below, and indicate the service project(s) for which they are necessary to complete.
- Please include any comments or questions below.
- By signing electronically below, I agree to host a worksite team from The Hartford Project on the above selected date(s), and confirm that I or the otherwise listed onsite supervisor will be present to welcome and instruct volunteers upon arrival.
  
  I also agree to keep students in safe working conditions, follow government guidelines regarding COVID-19, and to never ask students to work with or near poison ivy.
- Your Signature
- Onsite Supervisor's Signature
- Should be Empty: