Community Service Submission Form

Community Service Form
Name

First NameLast Name
Name of Chapter
Chapter Email Address
Ex: CharlotteGrad@gphig.org | CharlotteGrad@gmail.com
Name of Region
Name of Community Service Project:
Type of Community Service
Community Service Description
Date of the community service

MonthDayYear
Date
Community Service Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Names of Fellowmen Participants of Community Service Project:
Please list the names of the brothers in the photo from Left to Right.
Number of Community Service Hours Logged:
Scholarship Amount, if Applicable
Number of Recipients, if Scholarship:
Names of Recipients (Optional)
What are the age ranges of the youth that you mentored? (if applicable)
How many youth participated in the mentoring program? (if applicable)
How often do the mentors meet with the youth? (if applicable)
Is the mentoring project under the GphiG S.F.I. International Community Service Committee's GLA (Groove Leadership Academy)? (if applicable)
Donation Amount, if Applicable
Name/Organization Donation Recipient
Photos of the Community Service

Please list the brothers name in the photos from Left to Right.
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Supporting Videos of the Community Service

Please Upload high quality videos of
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Email address of the person submitting this form.
example@example.com
Phone Number
Format: (000) 000-0000.
Should be Empty:

Community Service Form