11Th Annual Martin Luther King Day of Service

PROJECT REGISTRATION FORM WHEN COMPLETING THIS FORM PLEASE …  Type or print clearly-- you may attach a business card where appropriate.  Photocopy this form if you are planning more than one project (fill out one form per project).  Questions? Contact Mela Still, Outreach and Programs Manager at (215) 851-1806 or [email protected].  To register instantly online, please visit our website at www.mlkdayofservice.org and click on the “Create a Project” button. T-SHIRT PRIORITY DEADLINE: FRIDAY, DECEMBER 1, 2017 I. Project Coordinator/Host Information The project coordinator is the leader of your project and the liaison with our headquarters. The project coordinator and host organization are responsible for all aspects of the project such as providing materials, picking up King Day T-shirts, etc. A. Project Coordinator (Name and Title): B. Host Organization (if applicable): C. Mailing Address: (City) (State) (Zip Code) D. Phone: Day ( ) Evening ( ) Fax ( ) E-mail: Alternate E-mail*: Website: *Please provide an e-mail address where you can be reached during non-business hours. E. Please check the issue(s) that your organization works to address. Select all that apply. □ Adult Education □ Animals □ Arts & Culture □ Children & Youth Education □ Civic & Community □ Disaster & Emergency Services □ Environment □ Faith-Based Services □ Family Services □ Health & Wellness □ Hunger & Homelessness □ Immigrant & Refugee Services □ Internships & Employment □ Justice & Legal Services □ Schools □ Senior Services □ Sports & Recreation □ Technology □ Veterans & Military Families □ Other Area: F. Please indicate if you are one of the following partners; you may leave this section blank if none apply. □ CB Cares □ Central PA MLK Committee □ DE State Office of Volunteerism □ EducationWorks – PA or NJ □ Girl Scouts of Eastern PA □ United Way of Lancaster County □ Phila. Dept. of Parks & Recreation □ Phila. Fire Dept. □ Pittsburgh Cares □ Phila. School District □ United Way of Bucks County II. Project/Event & Site Information Please complete one form for each project and number multiple registration forms. A. Please note what TYPE of project or event you will coordinate: IMPORTANT: Each project type needs its own registration. □ Outdoor Cleanup □ Indoor Cleanup/Painting/Etc. □ Food Packaging or Meal Service □ Children & Youth □ Training/Workshop □ Educational Activity □ Information Distribution □ Donation Opportunity □ Advocacy Event □ Sunday Supper □ Community Celebration or Concert □ Community Discussion □ Religious Service □ One King Day, One King Book □ Multiple Project Types B. Name of Project Site (may be same as host): C. Project Site Address (street)

(City) (State) (Zip Code)

D. County: (please check one) □ Philadelphia* □ Bucks □ Chester □ Delaware County, PA □ Montgomery □ Burlington, NJ □ Camden, NJ □ Other County (please specify): *If in Philadelphia, please indicate neighborhood location □ Center City □ North Philadelphia □ South Philadelphia □ West Philadelphia □ Far Northeast □ Lower Northeast □ Northwest □ Southwest Philadelphia E. Are you are you partnering with another organization on this project? (circle one) YES NO If yes, please provide the name of the other organization: F. Time of Project: Start Time: AM or PM End Time: AM or PM Project Date: □ January 15, 2018 □ Other: (please specify) F. Brief description of project (Attach additional sheet if necessary.):

G. Total # of volunteers that will participate in your project: H. Total # of coordinators that will lead your project: I. # of people to benefit from or be served by your project: J. # of individuals from the general public that will participate in your project: K. # of veterans to participate in your project: L. # of active military members to participate in your project: M. # of members of military families to participate in your project: N. What age range(s) of volunteers will be involved in this project? Ages □ 5-9 □ 10-13 □ 14-18 □ 18-64 □ 65+ O. We can recruit volunteers for your project using our online system. (circle one) YES NO Would you like us to recruit volunteers for your project? If yes, please complete the next section in FULL. If no, skip part III and complete part IV. III. Volunteer Recruitment Information Please complete ONLY IF YOU NEED our headquarters to provide you with additional volunteers. A. How many additional volunteers would you like from King Day of Service headquarters? # of Volunteers: B. What age range(s) of additional volunteers would you like for this project? (Check ALL that apply) □ 5-9 □ 10-13 □ 14-18 □ 18-64 □ 65+ C. What tasks will the volunteers be required to perform (not the same as description)?

D. Will a meal be provided for volunteers? (Circle one) YES NO F. Is this project kid friendly? (circle one) YES NO G. Is this project wheelchair accessible? (circle one) YES NO IV. T-Shirt Order Due to overwhelming demand we cannot guarantee how many shirts each project will receive. Priority will be given to organizations that submit completed registrations by the deadline on Friday, December 1, 2017.

Would you like to request t-shirts for your service projects:

YES NO

G R E A T E R P H I LA D E LP H I A M A R T IN L U T H E R K I N G D A Y O F S E R V I C E c/o Global Citizen 1207 Chestnut Street, 6th Floor Philadelphia, PA 19107 Phone 215.851.1811 Fax 267.519.6230 Email [email protected] Register online at www.mlkdayofservice.org