Nebraska State Student Nurses Association Community Service Hours Submission Form 2025 - 2026
Deadline: January 31st, 2026 at 11:59 PM
No submissions after this date will be counted towards the totals. This application is used to apply for the community service awards (Individual & Chapter). This form is to be completed every time or must have necessary information for each date and time.
Please indicate where the hours are to be dedicated:
*
Individual - "Heart of the Community Award"
Chapter - "United in Service Award"
School Information:
School of Attendance:
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please fill out the Information below based upon which Award you Selected above:
Indiviual:
Name (First & Last)
NSNA Membership Number
Location of Community Service
Address
Date of Completion
Time Frame (ex: 0800 - 1200)
What was completed/done for the service hours (describe what you did)
Chapter:
Location of Community Service
Address
Date of Completion
Time Frame (ex: 0800 - 1200)
What was completed/done for the service hours (describe what individuals did)
Number of Nursing Students Involved/Completing Service Hours that day
Please use the information above & write in that format (bullet points are accepted):
*
What was learned from these community service hours?
*
Did student(s) receive class credit for participation in these community service hours? If so, please explain
*
File Upload: Please attach any pictures, documents, or additional materials that are from these hours
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