| Please take 5 minutes to fill out this form telling us about your service project. Use this form to register all project(s) that took place on the same day of service in the same state.
If you have any questions, please email Kisha James at
KJames@Pointsoflight.org
Please note:
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If you are pre- or post-registering a Make A Difference Day project, please use the official Make A Difference Day DAYtaBank.
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If you are pre- or post-registering your JOIN HANDS DAY, please use the official JOIN HANDS DAY website.
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| * Required fields. |
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I am filling out this form before the event, as a "pre-event registration." *
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I am filling out this form after the event, as a "post-event registration." *
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| I.
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Contact Information |
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Salutation* |
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First name* |
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Last name* |
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Title* |
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| II.
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Organization
Type |
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I am affiliated with a/an* |
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My organization is affiliated
with the Points of Light Foundation through a/an* |
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Click here to see if your national organization is a Connect America
Partner |
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I am a member of the Points of
Light Foundation |
Yes
No |
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Please contact the Membership office at the Points of Light Foundation
at Membership@pointsoflight.org
or 202-729-8131 for assistance.
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| III.
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Organization Information |
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Organization Name*
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Organization Address
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Street* |
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City* |
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State/Province* |
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Zip Code* |
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Country* |
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Day Phone |
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Evening Phone |
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Fax |
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E-mail Address* |
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| IV. |
Project
Information |
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This project will take place/took
place during* |
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Project Date* (mm/dd/yyyy) |
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How many projects
will take place/took place on this day?* |
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Project Name(s) |
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Project Location |
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City |
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State/Province |
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Zip Code |
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| V. |
Volunteer
Information |
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Approximately how
many volunteers will participate/participated in these projects?*
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Breaking down this
total number of volunteers, approximately how many of the volunteers will be/were: |
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Youth and Young Adults (0 - 25
years) |
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Adults (26 - 54 years) |
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Older Adults (55 years and older)
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If you engaged volunteers
from the following categories in your service project(s), how many were
involved? |
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Families |
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Number of individuals that make up the above number of families |
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Persons with disabilities |
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| VI. |
Partner
Information |
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How many organizations will partner/partnered
in these projects?* |
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Identify up to 6 principle partner
organizations who will participate/participated in these project(s). |
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| VII. |
Project Focus
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Your project(s) will focus/focused
on addressing the following issues: (choose all that apply) |
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If other, please specify |
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| VIII. |
Project Description*
Please briefly describe (150 words or less) the most important outcomes of
your project and give examples (e.g. we removed a ton of trash from a
stream that can now support aquatic life; we held a book fair collecting
500 books that were given to a local elementary school). |
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| IX. |
Media Opportunities |
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If you received media coverage for your service project,
what type of coverage was it (choose all that apply)?
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If you tracked the number of media mentions your project received,
please list the number of times below:
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Radio |
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Television |
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Print |
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Web |
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Please help us create a scrap book by attaching photos from your service project.
Attachments:
(word, excel, pdf, zip, text, html or image attachments only) |
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Yes, please keep me informed of Points of Light Foundation
activities and initiatives. |
Yes
No
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