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
Scholarships

Please enter the Total Number of Recipients for the Scholarship and the Average Amount of Scholarships Awarded
Number of Scholarships
Enter as a number (e.g. 5, 10, 25, etc.)
Amount Awarded
This should be the amount of each scholarship and not the aggregate amount awarded. If multiple scholarships were awarded in different amounts, use an average amount.
Community Service

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

Other
Number of Volunteers
Enter as Number (e.g. 5, 10, 25, etc.)
Average Number of Hours
This is for each volunteer. Do not aggregate. If multiple volunteers volunteered different number of hours, use an average number of hours.
Average Number of Miles
This is for each volunteer to and from the event. Do not enter total miles. If members came from different locations, use an average number of miles.
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 number (e.g. 1.00, 500.00, 5,000.00, etc.)
Charitable Organization

Other
Brief Project / Event Description
Should be Empty:

USCNJPHA - Making A Difference Report

Scholarships

Community Service

Charitable Donation