This form must be thoroughly completed and approved BEFORE the project is started.  Failure to do so will result in a loss of credit. You are not applying for a  project, but REGISTERING your project.  You will be notified once it is
determined that your project fits the Gold Project Guidelines.

Student Information

Student Name:

Year of Graduation:

Name of Agency:

Supervisor Information

Title & Name:

Address:

City, State, Zip

Business Phone:

Home Phone:

Project Details

Starting Date:

Ending Date:

Estimated Hours:

Describe your project.  What will you be doing on a day-to-day basis?  Be specific.

How will this project directly undertake one or more of the Works of Mercy?

Will you be DIRECTLY serving another person or persons?  How?

Electronic Signature:

Student E-Mail Address:

Parent E-Mail Address:

Today's Date:

Please type the Last 4 Digits of your SSN