Court-Ordered Community Service Screening Form

Court-Ordered Community Service Screening Form

Please fill out all required fields to complete your screening.
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
List your charges or pending charges
Upload documentation from the courts stating your requirement to complete community service hours

Cancelof
Number of community service hours required
Deadline to complete the hours

MonthDayYear
Date
Days and times you are available

Other
Full name of probation officer, lawyer, or other point of contact

First NameLast Name
Phone number of point of contact
Please enter a valid phone number.Format: (000) 000-0000.
Email address of point of contact
example@example.com
I have read Habitat for Humanity of Southeast Indiana's Community Service Volunteer Policy and Guidelines (available on HFHSEI's website). I understand and agree to abide by the policies and guidelines while volunteering with Habitat for Humanity of Southeast Indiana.
Signature
Should be Empty: