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 Managerat (215) 851-1806

To register instantly online, please visit our website at 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

  1. 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 ( ) / Evening ( ) / Email:
E. Please check the issue(s) that your organization works to address. Select all that apply.
Adult Education / Faith-Based Service / Schools
Animals / Family Services / Senior Services
Arts & Culture / Health & Wellness / 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 / Central PA MLK Committee / DE State Office of Volunteerism
EducationWorks (PA or NJ) / Girl Scouts of Eastern PA / United Way of Lancaster County
Phila. Dept. of Parks & Recreation / Phila. Fire Dept. / Pittsburgh Cares
Phila. School District / United Way of Bucks County / Other Partner (specify below):

II.Project/Event & Site Information

Please complete one form for each project and number multipleregistration forms.

A. Please note what TYPE of project or event you will coordinate:
Outdoor Cleanup / Indoor Cleanup/Painting/Etc. / Food Packaging/Meal Service
Children & Youth / Other / Training/Workshop
Educational Activity / Information Distribution / One King Day, One King Book
Donation Opportunity / Advocacy Event / Sunday Supper
Community Celebration or Concert / Community Discussion / Religious Service
B. Name of Project Site (may be same as host):
C. Project Site Address (street):
(City): / (State): / (Zip Code):
D. County: (please check one)
Philadelphia* / Bucks / Chester
DelawareCounty, 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: AM or PM
Project Date(s):
F. Brief description of project (Attach additional sheet if necessary.):
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 / Young Adults / 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 sectionONLY 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? / (Circle one) YES NO
E. Is this project kid friendly? / (Circle one) YES 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 liketo 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 Fax267.519.6230 Email Register online at

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