A L P H A P H I A L P H A F R AT E R N I T Y , I N C .
®
| 2313 ST PAUL STREET, BALTIMORE, MD 21218 - 5211
Community Service Form
Chapter Name
Date(s) of Event Month/Day/Year
Name of Event
Location
Benefiting Organization(s) Benefiting Organization(s) Contact Person(s) Event Description
Type of Event:
_______ Community Service (e.g., hands-on) _______ Philanthropy (e.g., fundraising) _______ Indirect Service/Support (e.g., participation in other groups Philanthropies, food drives, blood drives, etc.)
Volunteers/ Service Hours:
The number of members (from your chapter) participating by the number of hours each member worked. Only submit the hours volunteered during the actual event (not preparatory work). EXAMPLE: 15 members x 2 hours each = 30 total hours 63 members x 1 hour each = 63 total hours Total volunteer hours = 93 total hours
_____ Members x ______ Hours each = _______Total Hours
PLEASE NOTE:
_____ Members x ______ Hours each = _______ Total Hours
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Forms are utilized as a way to keep a record of your chapters’ involvement in the community.
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Turn in one form per service event.
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Forms are due 10 days following event
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Each participating chapter must turn in a form in order for hours and money to be recorded.
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Forms must have signature of Agency/Organization to be valid.
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Submit forms to Cory J. Anderson in Membership Department
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Membership@apa1906.net
TOTAL
= _______ Total Hours
Money Raised/ Philanthropy: Total Amount of Money Donated: $_______________ (Please only include money that your chapter raised and is donating directly to a charitable organization. Thus, any money donated to another Chapter should not be included on this report, so as to not double count total money raised/donated). Verification: My signature verifies that the above information is true and accurate.
Signature of Chapter Representative
Date
Signature of Agency/Organization
Date
Phone: 410.554.0040
Page 1 of 1 original.file 4/7/2010