Community Service Hour Submission

1
Your Name* This field is required.What is the name of the student that completed community service hours?
First Name
Last Name
2
Year of Graduation* This field is required.
Please Select
Please Select
2025
2026
2027
2028
3
Student Email* This field is required.Please enter your school-issued email address
example@example.com
4
School Counselor* This field is required.
Please Select
Please Select
Mr. Connors
Ms. Fajardo
Mr. Loring
Ms. Mello
Ms. Montague
Ms. O'Donnell
Ms. Staunton
5
Community Service Hours* This field is required.Total Hours Submitting
6
Start Date of Service* This field is required.When did you start this community service work?
Date
Month
Day
Year
7
End Date of Service* This field is required.When did you complete this community service work?
Date
Month
Day
Year
8
Name of Organization* This field is required.
9
Organization Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
10
Identify need and describe service activity* This field is required.
11
How have you helped or improved the community or agency?* This field is required.
12
Additional relevant documentation to support application.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
13
Name of Community Service Supervisor/Contact* This field is required.
First Name
Last Name
14
Position/Title of Community Service Supervisor/Contact* This field is required.
15
Email Address of Community Service Supervisor/Contact* This field is required.
example@example.com
16
Phone Number of Community Service Supervisor/Contact* This field is required.
Please enter a valid phone number.
17
Certification Signature* This field is required.I certify that all statements and information furnished on this form are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. I understand that statements or information furnished on this form are subject to verification, and I agree to furnish supporting documents or information when so requested and/or names, addresses, and phone numbers. I also understand that intentional misstatements or falsification may result in disciplinary action, including but not limited to not being able to graduate on time.
Clear
18
Certification Name* This field is required.I certify that all statements and information furnished on this form are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. I understand that statements or information furnished on this form are subject to verification, and I agree to furnish supporting documents or information when so requested and/or names, addresses, and phone numbers. I also understand that intentional misstatements or falsification may result in disciplinary action, including but not limited to not being able to graduate on time.
First Name
Last Name
Should be Empty: