1.0 Group Leader Interest Form

Group Leader Interest Form

Organization Name

Group Type

Please select... College/Univ Community Corporation Government K-12 Non-profit Other Religious

Grade Level

Please select... Preschool - Kindergarten 1st - 4th 5th - 8th 9th - 12th

Phone

Organization Address 

City

State

Please select... AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Postal Code

Group Leader Contact Information

First Name 

Last Name

Email

Cell Phone

If you do not have a cell phone number, enter in another phone number unique to you.

Volunteering Request Details

Total # of Volunteers Anticipated

Anticipated Number of Chaperones

Date Request - 1st Choice

Date Request - 2nd Choice

Date Request - 3rd Choice

Location Preference

Please select... North Grafton (04/29 thru 11/01) Harvard (9/1 - 10/15 M,T,W,F 9-12 only, groups of up to 30 participants per day)

Notes/Special Requests