Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00. XXXX, XXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) 21. AGENCY CONTACT EMAIL & PHONE 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:
Appears in 4 contracts
Samples: Service Agreement, Service Agreement, Service Agreement
Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXXX XXXXXX XXXXXXX 00. XXXX, XXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) 21. AGENCY CONTACT EMAIL & PHONE 22. REIMBURSEMENTS APPROVED: Yes No Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:
Appears in 4 contracts
Samples: Volunteer Service Agreement, Volunteer Service Agreement, Volunteer Service Agreement
Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00. XXXX, XXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) 21. AGENCY CONTACT EMAIL & PHONE 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:
Appears in 3 contracts
Samples: Service Agreement, Volunteer Service Agreement, Service Agreement
Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00. XXXXSTREET ADDRESS CITY, XXXXXSTATE, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) 21. Xxxxx, Xxxxxx AGENCY CONTACT EMAIL & PHONE 22. Xxxxxx_xxxxx@xxx.xxx (000) 000-0000 REIMBURSEMENTS APPROVED: Yes No Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:
Appears in 1 contract
Samples: Volunteer Service Agreement
Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00STREET ADDRESS 19. XXXXCITY, XXXXXSTATE, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) XXXXX, XXXXXXX 21. AGENCY CONTACT EMAIL & PHONE xxxxxxx_xxxxx@xxx.xxx 540.999.3500 x3181 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:: PATC VIP
Appears in 1 contract
Samples: irp.cdn-website.com
Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00. XXXX, XXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) Xxxxxx, Xxxxxxxx 21. AGENCY CONTACT EMAIL & PHONE xxxxxxxx.xxxxxx@xxxx.xxx; (000)000-0000 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes ✔ No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:: Trail Maintenance
Appears in 1 contract
Samples: Volunteer Service Agreement
Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00STREET ADDRESS 19. XXXXCITY, XXXXXSTATE, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) 21. AGENCY CONTACT EMAIL & PHONE 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:
Appears in 1 contract
Samples: Service Agreement
Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00. XXXX, XXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) Xxxxxxx, Xxxx 21. AGENCY CONTACT EMAIL & PHONE 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:Xxxx_Xxxxxxx@xxx.xxx 510‐792‐0222, x361
Appears in 1 contract
Samples: Service Agreement
Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00. XXXX, XXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) 21. AGENCY CONTACT EMAIL & PHONE 22. REIMBURSEMENTS APPROVED: Yes No Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:
Appears in 1 contract
Samples: Service Agreement
Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00. XXXX, XXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) Xxxxxxx, Xxxx 21. AGENCY CONTACT EMAIL & PHONE Xxxx_Xxxxxxx@xxx.xxx 510-792-0222, x 361 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes ✔ No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:: Cleanup Volunteer
Appears in 1 contract
Samples: Service Agreement
Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00. XXXX, XXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) XxXxxxxxx, Xxxxx 21. AGENCY CONTACT EMAIL & PHONE 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:xxxxxxxx@xxx.xxx
Appears in 1 contract
Samples: Service Agreement
Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00. XXXX, XXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) Xxxxx Xxxxxx 21. AGENCY CONTACT EMAIL & PHONE xxxxx_xxxxxx@xxx.xxx 000-000-0000 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:
Appears in 1 contract
Samples: Service Agreement
Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00. XXXX, XXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) Xxxxxxxx, Xxxxxxx 21. AGENCY CONTACT EMAIL & PHONE 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:Xxxxxxx_Xxxxxxxx@xxx.xxx; 000-000-0000
Appears in 1 contract
Samples: Service Agreement
Ethnicity. (Select one): Hispanic or Latino Not Hispanic or Latino 14b. Race (Select one or more, regardless of ethnicity): American Indian or Alaskan Native Asian Black or African American White Native Hawaiian or Other Pacific Islander 14c. Are you a Veteran? Yes No 14d. Do you have a disability? Yes No EMERGENCY CONTACT INFORMATION 15. NAME (Last, First) 16. PHONE Home: Mobile: 17. EMAIL ADDRESS 18. XXXXXX XXXXXXX 00. XXXX, XXXXX, ZIP CODE GOVERNMENT OFFICIAL COMPLETES THIS SECTION 20. AGENCY CONTACT NAME (Last, First) Xxxxxx, Xxxxxx 21. AGENCY CONTACT EMAIL & PHONE 000.000.0000/xxxxxxx@xxx.xxx 22. REIMBURSEMENTS APPROVED: Type and Rate of Reimbursement: Yes ✔ No 23. VOLUNTEER POSITION/GROUP PROJECT TITLE:: IFNM Restoration
Appears in 1 contract
Samples: Volunteer Service Agreement