Lift Lodi Outdoor Project Request Form

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This project request form is for our elderly or disabled residents needing assistance during Our Annual Day of Service on May 20, 2023. These projects will need to be for the City of Lodi & Town of Lodi only.

Name *

Phone Number *

Email Address

Address of the Home/Project Site *

Location of Address

City of Lodi

Township of Lodi

Clear selection

Please describe the full scope of your outdoor project. (Examples: raking leaves, weeding, planting flowers (you provide), mulching (you provide), trimming trees/hedges, cleaning debris, clean gutters, outside painting (you provide), outside window washing)

What tools or equipment will be supplied by the requester?

Please list the supplies you will need provided by the project team:

What length of time do you anticipate the project will take?

up to 2 hours

2-4 hours

Clear selection

Will volunteers have access to an on-site restroom?

Yes

Clear selection

I am willing to have a volunteer from Lift Lodi come to my home to assess/review the project needs.

Yes

Clear selection

I understand that the submission of this request does not guarantee that this project will be selected for the Day of Service.

I agree

Typed Signature and Date Signed

Submit

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