Service and Philanthropy Activity Record
Activity Submission Form

Please use the form below to submit activities to an organization's Service and Philanthropy Activity Record. Any member of the organization may submit group activities. Please allow 7-10 business days for your activities to be verified and added to the record.

Questions about the Service and Philanthropy Activity Record can be directed to Bryan Rotach, Assistant Director of Operations of the Rochester Center for Community Leadership.

All Field are Required

Name of Campus Organization (as it is registered):
Name of Individual Submitting Form:
Relationship to the Organization:
Email Address:

Activity:
Select One:
 Community Service
Philanthropy
Other
Date of Activity:

Total Hours Spent at Activity:
[Number of volunteers] * [Number of hours at volunteer location] =

Total Hours Spent Planning for this Activity:
[Number of planners] * [Number of hours spent planning for activity] =

Description of Activity (describe what you did and who was involved):

Outcomes of Activity (what did you accomplish, how much did you raise, what did you do that made a difference):

The activity listed above will become part of your official record after the nature and extent of your organization's involvement is verified. Please provide the name and contact information of a person who can verify your organization's participation in the activity listed above. The person should NOT be someone in your organization, and should be a contact person at the agency at which your volunteered or your advisor.

Name:
Organization or Title:
Phone Number:
Email Address: (put N/A if not available)