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Days of Caring Agency Registration

* required information
Days of Caring Agency Registration Form 
Primary Contact for Days of Caring
Please enter your contact information and the address where the project will take place.
Requesting Agency:*
First Name:*
Last Name:*
Email:*
Address Line 1:*
Address Line 2:
City:*
State:*
ZIP/Postal Code:*
Phone:*
Fax:
Form Identification:
Project Information
If you would like to request multiple projects please fill out and submit a separate form for each volunteer assignment.
Project Month:*
Project Date(s):*
Ongoing Project:* Yes
No
Please list your project(s):
Will your agency supply all materials: Yes
No
If Yes, please describe:
Minimum number of volunteers needed:
Maximum number of volunteers needed:
Project will last: 4hrs
8hrs
other
If Other, please describe:
Project Available: Anytime
8a.m. - 12 noon
12 noon - 4 p.m.
9 a.m. - 3 p.m.
Other
Other, project is available:
Will beverages and/or lunch be provided by your agency: Yes
No
If Yes, please describe:
If No, is there a cafeteria or restaurant close by (please describe):
Will an agency representative be available to give a brief informational orientation on your agency's programming and services to the volunteers: Yes
No
Will there be direct contact with clients?: Yes
No
Questions? Contact Mary Kate Tarr at 216-436-2123 or mtarr@unitedwaycleveland.org.