Community Service Engagement

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Coach Name (first and last) *

Email address *

Sport *

Select Sport From Drop Down List

Name of Service Event *

Description of Community Service Event *

Date of Service Event *

Start Time of Service Event *

End Time of Service Event *

Total Number of Service Hours Student-Athletes Will Be Working *

Location/Address of Service Event *

What/Who does the activity benefit *

Ex., Children/Youth, Civic and Community, Animals, Arts and Culture, Environment, Disaster Relief, Health, Working with senior citizens etc.

List First and Last Names and Phone Numbers of Student-Athletes Participating in Event *

Name of Community Group/Organization *

Site Coordinator Name from Organization/Group *

Site Coordinator Email Address *

Site Coordinator Phone Number *

* required field