Project Inquiry Form
Project Inquiry Information
Company Name
Prefix	Dr. Mr. Ms.
Contact First Name *
Contact Last Name *
Street
Street 2
City
State	ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING AMERICAN SAMOA FEDERATED STATES OF MICRONESIA GUAM MARSHALL ISLANDS NORTHERN MARIANA ISLANDS PALAU PUERTO RICO U.S. MINOR OUTLYING ISLANDS VIRGIN ISLANDS ARMED FORCES AMERICAS ARMED FORCES ARMED FORCES PACIFIC ALBERTA BRITISH COLUMBIA MANITOBA NEW BRUNSWICK NEWFOUNDLAND NOVA SCOTIA NORTHWEST TERR. NUNAVUT ONTARIO PRINCE EDWARD ISLAND QUEBEC SASKATCHEWAN YUKON
Zip
Contact Email *
Please Note- Our communication is performed through email. If you prefer to be contacted by telephone, please let us know.
Cell Phone Number
Work or Home Phone Number
I prefer to be contacted by telephone
If you are a group, please indicate what best describes the group. Check all areas that apply. Community Organization Corporate Non profit Organization Faith Based Organization Civic / Government Academic Association- Honor Society, Etc. Group connected with a hospital (Nurse/Doctor Association, Board, Etc.) Education- College Level Education- Grades PK-12 Club Rotary
Other, please describe
How did you hear about IMD Guest House? Please check all that apply. Volunteer Fair VolunteerMatch.org A Volunteer IMD Guest House Staff or Administrative personnel IMD Guest House Website Internet Other
Proposed Project Date
1st Preferred Volunteer Date *
2nd Preferred Volunteer Date
Donated Items for Project:
Additional Inquiry Information
Community Room Project Selection (All weekday projects must end by 8:00 p.m. and all Saturday projects must end by 2:00 p.m.) Evening Meal Maker (Volunteers arrive by 5:00 p.m.) Grab 'n Go Breakfast (Volunteers arrive by 8:00 a.m.) Weekday Baker (9:00 a.m. - 8:00 p.m.) Saturday Breakfast (Volunteers arrive by 8:00 a.m.) Saturday Baker (Volunteers arrive by 10:00 a.m.)
Other Projects: Guest Greeter Welcome Baskets Comfort Cards Administrative / Clerical Special Events
Other- (Please describe)
Completing Volunteer Hours as a Requirement?
Require verification of volunteer hours? * Yes No
If yes, how many hours?
Due date for requirement of volunteer hours	// (MM/dd/yyyy)
Complete Inquiry
Questions or for more information about volunteer opportunities, please contact the Volunteer Coordinator at 312-996-9287

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