Agency Project Submission Form

Agency Name*

Contact First Name*

Contact Last Name*

Phone*

Email Address*

Project Name

Project Description*

Number of volunteers needed*

Project Address (include City, Zip)*

Please indicate time(s) project takes place [All Day, Morning (8:30 AM - 12 PM) or Afternoon (1 - 5 PM)]*

Materials and items volunteers must provide (be specific - if nothing is required, enter N/A)

Project Level

Easy
Medium Difficulty
Difficult

The following is applicable only when MAJOR renovations or demolition is requested.

Approved by the Board on (date)

Submit only one form per project. If you have questions, please contact Amy Fisher at (434) 455-6919 or Laura Lawson at (434) 455-6900. Thanks!