Organizer/Organization Information

Name of School (if applicable):

Name of Organization:

Name of Organizer (main contact):

Title:

Address:

City:      State:      Zip:

Phone:

Fax:

Email (required):

Project Information

Type of Project:

Education
Environmental
Elderly
Literacy
Human Needs
Public Safety
Other (specify)

This project will consist of the following elements:

Service
Advocacy
Public Speakers
Reflection
Celebration
Awareness/Education
Other (specify)

Number of volunteers that will participate (anticipated): Please select... 0 to 10 10 to 20 20 to 30 30 to 40 40 to 50 50 or more

Would you like VCC to advertise this event as open to other volunteers? Please select... Yes No

Would you like VCC to advertise this event as needing a youth leader? Please select... Yes No

Please give a summary of the planned project or event:

Location of project:

County (required): Please select... Addison Bennington Caledonia Chittenden Essex Franklin Grand Isle Lamoille Orange Orleans Rutland Washington Windham Windsor

Event Date: January February March April May June July August September October November December 2008 2009 2010

Event Time: : AM PM

Are you applying for a mini-grant for this event?  Please Select... Yes No