YOUTH / ADULT AWARDS — VOLUNTEER SERVICE LOG (To be completed by Nominee)
Is this a NEW SUBMISSION or an ADDITION TO YOUR FIRST SUBMISSION?
NEW SUBMISSION FOR VOLUNTEER LOG
ADDITIONAL SUBMISSION FOR VOLUNTEER LOG
Are you filling this out for Youth or Adult Nominee?
Name of Nominee
Please enter a valid phone number.
Please use a valid email address.
Street Address Line 2
State / Province
Postal / Zip Code
This volunteer service log MUST include community volunteer service performed in 2023; then list prior volunteer service in “PUTNAM COUNTY” within the last 4 years.
TYPE OF SERVICE PERFORMED
APPROXIMATE DATES OF SERVICE (Example: 1/2019 to 1/2023)
TOTAL # OF SERVICE HOURS
Contact Person, Address, & Phone Number
Please Confirm that your Information is Accurate
Still Need to Check
Should be Empty: