Community Service Registration Form

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Community Service Registration Form
Date of Community Service Event:________________
Please fill out the appropriate field. Is this community service form for a:
□ Club/Organization:_______________________ □ Class: ________________________
□ Scholarship_____________________________ □Self __________________________
Person Filling Out Form:
______
Community Service Activity:
Agency/Organization/Project Name:___________________________________________________________
(Example: AIDS Walk NY, YMCA or Hoboken Soup Kitchen)
Agency/Organization/Project - Contact Person:
______
Phone Number:
Email:_____________________________________
Description of Community Service (Be Specific):
List students/members who participated in the community service activity and hours each participated in:
Name:
Hours:
Name:
Hours:
Total Group Hours Completed:
The signatures below verity that the club or organization has volunteered services to the above mentioned agency
Authorized Agency Signature MUST be from a representative of the organization where community service was performed.
Agency/Organization/Project Signature: __________________________
Date:
(Representative from Community Service Recipient)
Advisor Signature:
Date:
BCSG/Greek Council VP Signature:
Date:
CSLE C.S. Coordinator Signature:
Date:

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