Care Project Request Form - United Way of Metro Chicago

Please fill out this form if you are interested in a United Way facilitated kit project. United Way will order supplies, provide instructions, and send our staff to lead the project on the day of your event. Pricing will vary depending on the number of volunteers, time allotted, and kit option chosen.

Contact Information*
First Name Last Name
Company Name*
Company Address*
Job Title*
Email*
Phone*
Facilitated Care Project Budget (Please provide an exact dollar amount. Pricing will vary depending on the number of volunteers, time allotted, and kit option chosen.)*
.
Number of Volunteers Participating in the Facilitated Care Project (please provide an exact number)*
Three Preferred Dates for Executing the Facilitated Care Project.*
NOTE: All care project requests must be made a minimum of 4 weeks prior to your date of facilitation. Dates less than 4 weeks from your request submission will not be considered.
Shipping Information (where materials/supplies can be shipped)*
Shipping Address Address Line 2 City State / Province / Region ZIP / Postal Code
Please provide any additional information you think we should know regarding your facilitated care project request.
Agreement to execute care project.*
I confirm my responsibility for all fees incurred as part of the requested facilitated project.

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