#NPHCUnited4Service
Reporting Form
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Date of Event:
-
Month
-
Day
Year
Date
Orientation Location:
Member Organization Present:
ΑΦΑ
ΑΚΑ
ΚΑΨ
ΩΨΦ
ΔΣΘ
ΦΒΣ
ΖΦΒ
ΣΓΡ
ΙΦΘ
Total Attendance:
Total Event Cost:
Time in Hours:
Donations:
Monetary Amount:
And/or # of Items :
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NPHC Council Information
Council Name:
Council Size:
(# of member organization)
University (if applicable):
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Council President
#NPHCUnited4Service Coordinator:
E-mail
example@example.com
Mobile Number
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Work Site Information
Name of Agency:
Briefly Describe Service Provided:
Name of Agency:
Briefly Describe Service Provided:
Name of Agency:
Briefly Describe Service Provided:
Name of Agency:
Briefly Describe Service Provided:
Name of Agency:
Briefly Describe Service Provided:
Name of Agency:
Briefly Describe Service Provided:
Submit any photos, newspaper clippings, and links to media coverage.
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Additional Program Information:
If you have more than six worksites, please feel free to email the necessary information to programmingchair@nphchq.com. After the reporting form is submitted, please retain a copy of your council records' reporting form.
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