USCNJPHA - MAD v2.0

USCNJPHA - Making A Difference Report

This form is used to record Making A Difference acts of service. Please be sure to answer all applicable questions.
Please enter the name and contact information of the person entering the data
Name

First NameLast Name
Email
example@example.com
Service Project Date

MonthDayYear
Date
Organization*
Service Type*

ScholarshipCommunity ServiceCharitable Donation
Scholarships

Please enter the Total Number of Recipients for the Scholarship and the Total Amount of Scholarships Awarded
Number of Scholarships
Enter as a number (e.g. 5, 10, 25, etc.)
Amount Awarded
Enter as currency (e.g. 1.00, 500.00, 5,000.00, etc.)
Community Service

Please select the Type of Service provided as well as enter the Number of Volunteers, Hours for each Volunteer, Average Number of Miles to / from the Event and any Cost / Spend for the Event.
Type of Service Provided

MentorshipElderly AssistanceFood AssistanceVoter Registration / Voter OutreachHealth / Wellness AssistanceUnhoused AssistanceOther
Number of Volunteers
Enter as Number (e.g. 5, 10, 25, etc.)
Number of Hours
This is for each volunteer. Do not aggregate. Enter as number (e.g. 5, 10, 25, etc.)
Average Number of Miles
This is for each volunteer to and from the event. Do not enter total miles. Enter as number (e.g. 5, 10, 25, etc.)
Event Cost
This should capture any cost or spend outlaid for the event. Enter as currency (e.g 1.00, 500.00, 5,000.00, etc.)
Charitable Donation

Please enter the Total Amount of the donation made and to which charitable organization.
Total Donation Amount
Enter as currency (e.g. 1.00, 500.00, 5,000.00, etc.)
Charitable Organization

USC Benevolent FoundationNAACPDirect ReliefHunger ReliefWounded Warriors Family SupportAmerican Red CrossUnited WayUrban LeagueBoys & Girls ClubYMCA of the USASalvation ArmyGoodwillLegal Defense LegalNational Urban LeaguePrince Hall Colonial Day CareWilberforce UniversityNation Freedom Day AssociationNational Alzheimer’s AssociationOther
Brief Project / Event Description*
Should be Empty:

USCNJPHA - Making A Difference Report

Scholarships

Community Service

Charitable Donation