Community Service Form
Thank you for your interest in completing your community service hours with Rockford Area Habitat for Humanity. Please, entirely fill out the below information. Rockford Area Habitat for Humanity is committed to fostering an inclusive and welcoming environment for everyone, including the LGBTQ+ community. If you would like to share your pronouns with us, we encourage you to do so. Together, we can build homes, communities, and hope for those in need. We look forward to having you join our dedicated team!
Participant Information
Name
First Name
Last Name
Email
example@example.com
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Agency
Agency / Service Name
Contact Name
First Name
Last Name
Email
example@example.com
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Service Details
Date service court ordered
-
Month
-
Day
Year
Date
Ordered date of completion
-
Month
-
Day
Year
Date
Number of hours ordered to complete
Skills description
Availability
From
Hour Minutes
AM
PM
AM/PM Option
To
Hour Minutes
AM
PM
AM/PM Option
Select your available days
Submit
Should be Empty: