Our Family Foundation
Fighting Child Hunger
Associate Volunteer Program
Application Form
Associates who volunteer 10 or more hours for eligible hunger relief programs in 2013 may apply for a Fighting Child Hunger Associate Volunteer grant to a food bank/affiliate organization to fight child hunger in their community.
Individuals who volunteer for 10 or more hours can have their time matched with a $150 grant to the food bank/affiliate organization. Teams (which must consist of at least one associate) who volunteer can have their time matched at $15/volunteer hour, with a minimum of $150 for 10 hours of service and a maximum of $300 for 20 or more hours of service[1]. All grants will be made directly to the regional food bank partner.
Instructions
To be completed by the Associate volunteer. In the case of a team, one person should be designated as the coordinating applicant. Please print neatly or type.
Step 1: Complete Part 1 of this form
Step 2: Have the organization you volunteered for complete Part 2 of this form
Step 3: Mail both parts of the completed form to Nastassja Garcia at the following address. Applications will be reviewed on a rolling basis throughout the year and grants awarded quarterly. The final date for submission is October 31, 2013.
Our Family Foundation – Fighting Child Hunger Associate Volunteer Grants
c/o The Philanthropic Initiative
420 Boylston St., 4th floor, Boston, MA 02116
For all questions, please contact Nastassja Garcia, 617-338-5883, .
PART 1 – Associate Form
Section A. To be completed by all applicants
Associate Name:
Position:
Work location/Store number:
Department #:
Supervisor’s Name:
Ahold USA Division (check one)
ÿ Stop & Shop New England
ÿ Stop & Shop New York Metro
ÿ Giant Landover
ÿ Giant Carlisle
ÿ Ahold USA
Associate Home Address: ______
City/State/Zip: ______
Telephone Number: ______
E-mail Address: ______
Name of the organization for which you volunteered for 10 hours or more:
______
What did you learn from your volunteer experience? (We are interested in collecting stories or reflections from associates to use in communications about the program. Please let us know about your experience.)
Section B. To be completed by applicants for an Individual Fighting Child Hunger Associate Volunteer Grant, only:
ÿ I am applying for a $150 Individual Fighting Child Hunger Associate Volunteer Grant. During the time between January 1, 2013 – present, I have completed at least 10 hours of volunteer service at the organization listed above.
Applicant’s Signature______Date______
Number of volunteer hours completed for this organization between January 1, 2013 to present: ______
Section C. To be completed by applicants for a Team Fighting Child Hunger Associate Volunteer Grant:
ÿ We are applying for a Team Fighting Child Hunger Associate Volunteer Grant. During the time between January 1, 2013 – present, the team has collectively completed 10 or more hours of volunteer service at the organization listed above.
Team Coordinator Signature: ______Date: ______
Number of volunteer hours completed by the team for this organization from January 1, 2013 to present (team hours are calculated as a total of each member’s hours): ______
Our team includes a total of ______participants.
Teams must be made up of at least one associate.
List other team members below. Additional names can be attached on a separate piece of paper. Teams must consist of at least one Associate but do not need to be entirely comprised of associates. For team members who are Associates, please include information on the Associate’s work location/store number, department number and position.
1. Name: ______
Position: ______
Work location/Store number: ______
Department #: ______
2. Name: ______
Position: ______
Work location/Store number: ______
Department #: ______
3. Name: ______
Position: ______
Work location/Store number: ______
Department #: ______
4. Name: ______
Position: ______
Work location/Store number: ______
Department #: ______
5. Name: ______
Position: ______
Work location/Store number: ______
Department #: ______
PART II – Nonprofit Form
2013 Our Family Foundation – Fighting Child Hunger Volunteer Grants
An Associate or team consisting of at least one Associate who volunteers at your organization has applied for a Fighting Child Hunger Associate Volunteer Grant on behalf of your food bank partner. If approved, your regional food bank will receive a small grant from the Our Family Foundation. If your organization is itself a grantee of the Foundation’s Fighting Child Hunger initiative, you will receive the grant directly.
Please fill out this form and return it to the volunteer to submit to the Foundation.
Organization Name: ______
Mailing Address: ______
Name of Person Completing This Form: ______
Title of Person Completing This Form: ______
Phone: ______
Email: ______
Food bank partner:
Name of associate/volunteer(s): ______
Number of hours associate(s) volunteered between January 1, 2013 and present: ______
Brief description of volunteer activity: ______
______
______
Signature of organization staff member or volunteer coordinator Date
If you have any questions, or need additional information, please contact Nastassja Garcia at TPI:
· 617-338-5833
· .
4
[1] Individual associates or teams may apply for more than one Fighting Child Hunger Associate Volunteer Grant. Second applications will be matched contingent upon available funds.