Worksite Project Request Form

Your Contact Information
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*
Your Phone Number: Mobile*
Will you be the onsite supervisor the day students come to volunteer?*

Yes, I will.No, someone else will be the day-of supervisor.

Onsite 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
Onsite Supervisor's Phone: Mobile*

Signatures
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

Clear
Onsite Supervisor's Signature

Clear
Should be Empty: