Volunteer Services Program Application

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ITD 02722 (Rev. 5/01)

Idaho Volunteer Services Program Application

Volunteer Service is creditable work experience and through the Volunteer Services Program, volunteer groups and individuals give their time and talent engaging in Idaho transportation Department-approved activities not associated with the Adopt-A-Highway Program. Volunteers receive no wages or benefits and are not considered state employees for any purpose other than tort claims and injury compensation.

Volunteer Groups:

Group Name:		Number of Volunteers:
Contact Person:		Day Telephone Number:
Mailing Address:		Submitted By::
City, State, Zip		Date:

Volunteer Individuals:

Name:		Day Telephone Number:
Mailing Address:		Submitted By:
City, State, Zip:		Date:

Location of Service:

Type of Service (mark all options that apply):

Litter Pickup
Wildflower Planting/Maintenance: Graffiti Removal
Landscape Planting/Maintenance: State Highway Right-of-Way Beautification
Clerical: Yard/Building Maintenance
Other (Specify):

Dates of Service:

Page Last Modified: 5/22/2006 4:21:21 PM