Briefly include the history of the agency with the date of incorporation:

Agency's mission statement:

Project's Mission- How does this project fit within the mission of JLM?

Community Need- How will the community ultimately benefit from this project?

Target Population Select ... Male Female Both males & females

Age Range Select ... Preschool Elementary Middle School High School

Project's objectives/ goals- Identify specific activities of the project that will accomplish these goals. Any available timelines for addressing goals and objectives would be helpful. Briefly describe:

List any other community agencies involved with the project:

Detailed description of job, approximate time commitment including time for travel and training, skills needed for job and/or skills the volunteer will acquire, minimum number of volunteers needed for the project:

If applicable, describe training involved - How many hours/approximate time commitment, including time for travel, skills needed for job and/or skills the volunteer will acquire:

Location of project: (be specific)

Is parking provided? Select ... Yes No

Volunteer schedule (please check all that apply)

Time of Day (please click all that apply)

Include ways in which your organization intends to promote and partner with JLM through the proposed project. This can be listing JLM on your website, promoting JLM at your events, recognizing JLM in your publications, etc.

Include the total project cost (include status of financial requests from other organizations, if applicable), total amount of JLM funds requested, itemized budget showing proposed spending of JLM funds, and the agency's current annual operating budget.

Attached 501(c)(3) Letter

Attached list of current Board of Directors

Attached Annual Report