21stAnnual
Greater Philadelphia
Martin Luther King Day of Service
Pennsylvania . New Jersey . Delaware
Monday, January 18, 2016
Celebrating Dr. King’s Legacy By Turning
Community Concerns Into Ongoing Citizen Action
PROJECT REGISTRATION FORM
WHEN COMPLETING THIS FORM PLEASE …
 Type or print clearly-- you may attach a business card where appropriate.
 Photocopy this form if you are planning more than one project (fill out one form per project TYPE).
 Questions? Contact Tiffany Smith, Outreach and Programs Manager at (215) 851-1806 or Tiffany@globalcitizen365.org
 To register instantly online, please visit our website at www.mlkdayofservice.org and click on the “Register a Project” button
next to the “Home” button at the top of our website.
 T-SHIRT LOTTERY PRIORITY DEADLINE: TUESDAY, DECEMBER 1, 2015
I. Project Coordinator/Host Information
The project coordinator is the leader of your project and the liaison with our headquarters. The project coordinator and host
organization are responsible for all aspects of the project such as providing materials, picking up King Day T-shirts, etc.
A. Project Coordinator (Name and Title):
B. Host Organization (if applicable):
C. Mailing Address:
(City)
(State)
(Zip Code)
D. Phone: Day (
)
Email:
Evening (
)
E. Please check the issue(s) that your organization works to address. Select all that apply.
 Adult Education
 Animals
 Arts & Culture
 Faith-Based Service
 Family Services
 Health & Wellness
 Schools
 Senior Services
 Sports & Recreation
 Children & Youth Education
 Hunger & Homelessness
 Technology
 Civic & Community
 Immigrant & Refugee Services
 Veterans & Military Families
 Disaster & Emergency Services
 Internships & Employment
 Other Area (specify below):
 Environment
 Justice & Legal Services
F. Please indicate if you are planning a project through a partner organization; you may leave this section blank if
none apply.




Central Bucks (CB) Cares
EducationWorks (PA or NJ)
Phila. Dept. of Parks & Recreation
Phila. School District




Central PA MLK Committee
Girl Scouts of Eastern PA
Phila. Fire Dept.
United Way of Bucks County




DE State Office of Volunteerism
United Way of Lancaster County
Pittsburgh Cares
Other Partner (specify below):
II. Project/Event & Site Information
Please complete one form for each project and number multiple registration forms.
A. Please note what TYPE of project or event you will coordinate:
 Outdoor Cleanup
 Indoor Cleanup/Painting/Etc.




Children & Youth
Educational Activity
Donation Opportunity
Community Celebration or Concert




Other
Information Distribution
Advocacy Event
Community Discussion
 Food Packaging/Meal Service




Training/Workshop
One King Day, One King Book
Sunday Supper
Religious Service
B. Name of Project Site (may be same as host):
C. Project Site Address (street):
(City):
D. County: (please check one)
 Philadelphia*
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(State):
 Bucks
(Zip Code):
 Chester
 Delaware County, PA
 Montgomery
 Burlington, NJ
 Camden, NJ
 Other County (please specify):
*If in Philadelphia, please indicate neighborhood location:
E. Time of Project:
Start Time:
AM or PM End Time:
Project Date(s):
F. Brief description of project (Attach additional sheet if necessary.):
AM or PM
For Items G-M, please estimate your expected participation numbers for each item.
G. Total # of volunteers that will participate in your project:
H. Total # of coordinators that will lead your project:
I. Total # of people to benefit from or be served by your project:
J. How many of your total volunteers will be civilians (non-military)?:
K. How many of your total volunteers will be veterans?:
L. How many of your total volunteers will be active military?:
M. How many of your total volunteers will be members of military families?:
N. What age range(s) of volunteers will be involved in this project?
Children
Adults
Young Adults
Seniors
III. Volunteer Recruitment Information
A. We can recruit volunteers for your project using our online system.
Would you like us to recruit volunteers for your project?
(circle one)
YES
NO
***Please complete the rest of this section ONLY IF YOU ANSWERED YES TO A ABOVE***
B. Of your total volunteers, how many would you like recruited through Global Citizen?:
C. What specific roles will volunteers play in your project (e.g. participation, set up, clean up, facilitation, etc.)?
D. Will a meal(s) be provided for volunteers?
E. Is this project kid friendly?
(Circle one)
(Circle one)
YES
YES
NO
NO
F. Is this project wheelchair accessible?
(Circle one)
YES
NO
IV. T-Shirt Lottery
Due to overwhelming demand we cannot guarantee how many shirts each project will receive. Priority will be given
to organizations that submit completed registrations by the deadline on December 1, 2015.
Would you like to request t-shirts for your service project?
YES
NO
GREATER PHILADELPHIA MARTIN LUTHER KING DAY OF SERVICE
c/o Global Citizen 1207 Chestnut Street, 6th Floor Philadelphia, PA 19107
Phone 215.851.1811 Fax 267.519.6230 Email mlkdayofservice@globalcitizen365.org Register online at www.mlkdayofservice.org
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