	A	B	C	E	G	H	I	J	K
1	A Community Self-Help Project is any project to improve our school buildings or grounds, which is initiated and implemented by anyone, or any group, other than staff from Everett Public Schools - Maintenance & Operations Department. All school and community Self-Help Projects require prior approval by the Maintenance & Operations Department to ensure that each project is appropriate for our buildings and grounds, complements programs taught in our schools, and is completed to district standards.
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5		DATE:
6		NAME OF SCHOOL/SITE LOCATION:
7		NAME OF PROJECT:
8		DATE(S) OF PROJECT:				HOURS OF EVENT:
9		SCHEDULE/COMPLETION DATE:
10		PROJECT REPRESENTATIVE:
11		PHONE NUMBER:			EMAIL ADDRESS:
12		BUILDING ADMINISTRATOR'S NAME:
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14	A: TYPE OF PROJECT & TIMELINE
15			Art Display			Landscaping/Grounds Cleanup/Weeding
16			Athletic Equipment/Structures *			Pressure washing sidewalks
17			Benches/Picnic Tables			Reader Board Sign/Scoreboard(s) *
18			Cabinetry/Carpentry			Memorial Structure/Garden/Plants/Tree
19			Lighting/Electrical/Sound System			Playground Equipment (Must be professionally installed.)
20			Painting (such as playground maps)			Other:			*Permits Required
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22		Simple timeline for completing the project; include phases, if applicable:
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25	B: PROJECT FUNDING DETAILS
26		If applicable, tell us what grants you are/will be applying for:
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28		Funding: (Circle below; all that apply)			YOUR OVERALL BUDGET:
29		PTA/PTSA		ASB	ESD		Building		Other
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31	C: PROJECT PARTICIPANTS
32		WHO IS PARTICIPATING IN PROJECT: (Please describe below.)						Number of Persons Participating:
33			Volunteers:
34			NOTE: All volunteers must complete a Hold Harmless agreement.
35			Students:
36			HPS Employees:
37			Organization(s):
38			Contractor(s):
39			All professionals must be hired through Maint & Ops Department; funds deposited with EPS
40			Other:
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42	D: PROJECT DESCRIPTION
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44		Description of what your proposed project includes and where it will be located:
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46		*Attach drawings, pictures, and/or site and building plans as applicable to this application.*
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49	E: PROJECT NEEDS
50			Grounds Beautification/Landscaping Projects
51			*We would like to have the following, if available:*
52			Buckets			Bark (Not Always Available)
53			Paper Yard Waste Bags			Other:
54			We would like to borrow tools from the TOOL LIBRARY: **
55			Shovels			Rakes


56			Wheelbarrows	Other:
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58		NOT ALLOWED BY SELF-HELP PROJECT STAFF - ELECTRIC/POWER TOOLS (Such as weedeater, chainsaw, mower, etc.); PESTICIDES OF ANY KIND; BUILDING REPAIRS; TRIMMING OF BUSHES OR TREES
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61			Painting Projects
62		It is best that each school purchases their own set of stencils for playground painting
63			*We would like to have the following, if available:*
64			Paint	Rollers and Paint Pans
65			Brushes	Painter's Tape
66			Drop Cloths	Other:
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68		*All paint colors & paint type requires prior approval.
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71		Please have the site administrator and the sponsoring project representative sign below indicating their endorsement of the proposed project, and their understanding and agreement to the statements below:
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74		*1. We are responsible for obtaining all necessary funding and support to complete the project.*
75		*2. We will make reasonable efforts to adhere to our projected schedule.*
76		*3. We will comply with specified maintenance responsibilities.*
77		*4. Completing this application is not assurance we will receive approval.*
78		*5. We will not begin the project until we receive written approval to proceed.*
79		*6. We will obtain any and all permits as required.*
80	*Your application MUST be received AND APPROVED three-weeks prior to your projected start date.*
81	*Project sponsors* *may* *need to provide a Certificate of Insurance naming Everett Public Schools as additional insured. Contractors MUST provide a Certificate of Insurance.*
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84	*SIGNATURE OF SITE ADMINISTRATOR*				*DATE*
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86	*SIGNATURE OF PROJECT SPONSOR*				*DATE*
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88	RETURN COMPLETED AND SIGNED PROPOSAL TO EPS MAINT & OPS DEPARTMENT
89	2222 EVERETT AVE., EVERETT WA 98201 ATTN: MAINTENANCE & OPERATIONS DEPT
90	Email To: LSutton@everettsd.org
91	FOR EPS SELF-HELP PROJECT COORDINATOR USE ONLY:
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93	Date Application Received:			Application complete?	Y N
94				If no, need to send:
95	Certificate of Insurance needed? Y N			- Playground Checklist
96	Certificate of Insurance received? Y N			- Hold Harmless Form
97	Date of expiration:
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99	Items for FSD to provide:
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103	Application approved by Maintenance Supervisor:
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106	SIGNATURE:			DATE:
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108	Notification of approval sent to project group:
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111	DATE:	METHOD:	BY:
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113	SELF-HELP PROJECT COMPLETED ON:
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