Use dashes: xxx-xxx-xxxx
Name of group or organization
Line 1: Street Address;
Line 2: City, State, Zip
*Must be in Scott or Rock Island County
Number of Volunteers x Hours Worked (Ex: 50 x 3 hours = 150 hours)
Ex: tires, furniture, etc.
Please enter more details of your request. If none, enter "N/A". A member of our staff will respond as soon as possible.