6 Sc Station Roster

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Overview

Instructions
Stations
Station Types

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Sheet 1: Instructions

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Sheet 2: Stations

Project Information

Station Information: All fields are required

Date of completion of the list Today's Date:

Name of the organization where the assignment is performed Volunteer Station Name

Volunteer Station Supervisor First Name

Volunteer Station Supervisor Last Name

Mailing Address Line 1:

If necessary Mailing Address Line 2:

City

State

Zip Code (5-digit)

Zip Plus 4

Area Code and Phone Number (123-456-7890)

If a station supervisor does not have an email address, enter "none". Email Address

# of Unduplicated Vols

Please enter a single number. If the number varies, please give an average estimate. If volunteers from one station also work at another station, include them in the counts for both stations # Volunteers

See worksheet for a list. Station Type (Hospital, School, govt, …)

Veterans (Y/N)

Focus Areas and Objectives

Focus Areas and Objectives

Focus Areas and Objectives

Focus Areas and Objectives

Focus Areas and Objectives

Focus Areas and Objectives

Focus Areas and Objectives

Focus Areas and Objectives

Focus Areas and Objectives

Focus Areas and Objectives

Focus Areas and Objectives

Focus Areas and Objectives

Focus Areas and Objectives

Focus Areas and Objectives

Focus Areas and Objectives

Focus Areas and Objectives

Application/Grant #:

Sponsor:

Please use a descriptive title (not just "RSVP"). The title should be identical to the Project Title entered in eGrants. Project Title:

Project Director First Name:

Project Director Last Name:

Project Director Mailing Address Line 1:

If necessary Mailing Address Line 2:

City:

State:

Zip:

Area Code and Phone Number

Project Director Email

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Sheet 3: Station Types

Volunteer Station Types

Adult Correctional Agencies

Adult Day Care

All Others (specify)

Animal Welfare Programs

Area Agencies on Aging

Before and After School Care

Chambers of Commerce

Clinics (non-residential)

Community Development Non-Profits

Community-Based Environmental

Congregate Meals/Meals on Wheels

Courts

Day Care

Day Dare (Pre-elementary)

Developmental Disability Agencies (non-residential)

Food Banks/Gleaning Programs

Head Start

Home Health Agencies (public and private non-profit)

Hospices

Hospitals/Medical Centers

Juvenile Correctional Facilities

Libraries

Mental Health Programs (non-residential)

Multi-Purpose Centers (Including Senior Centers)

Multi-Purpose/Senior Centers

Museums

Native American Schools

Non-Head Start Pre-Schools (education focused)

Nursing homes/Convalescent Centers/Hospices

Other Community and Economic Development (specify)

Other Educational (specify)

Other Environmental (Specify)

Other Health Care Organizations (specify)

Other Public Safety (specify)

Other Social Service Agencies

Parks/Recreational Agencies

Police/Law Enforcement Agencies

Post-Secondary Institutions

Private School

Public Housing

Public School

Public/Congregate Housing

Public/Private Elementary Schools

Public/Private Secondary Schools

Rehabilitation Centers (excluding sheltered workshops)

Residential Long-Term Care Programs

Service Organizations (Lions, Elks, etc.)

Sheltered Workshops/Centers (vocationally focused)

Teen Pregnancy/Teen Parenting Programs

Thrift Shops/Coops

Total number of faith-based Stations / Volunteers

Transitional Shelters/Centers (e.g. homeless, abused, other short-term

Umbrella Environmental Orgs (EASI, Wildlife Society)

Veterans Hospital

Vocational Centers