AMERICORPS SERVICE ACTIVITY REPORTING FORM

Program Name:

Program Activity:

Date(s) of Activity:

Number of Hours Spent:

Number of your program’s AmeriCorps Members who participated: Total number of participants/people involved in the event:

Was this activity done in conjunction with a National Day of Service? If yes which one: Please describe the type of service that was conducted:

Please describe planning efforts for the event:

Did you collaborate with other AmeriCorps programs for this service activity?

If yes, please describe the collaboration and the name of the collaborating organizations.

Please submit any great stories from members, copies of pictures, copies of news articles, or describe any other publicity you received from your service.

Please provide contact information for someone from your program who we can contact for additional information about this event:

Name: Phone Number: Email:

OneStar Foundation | 816 Congress Ave., Ste. 900 | Austin, Texas 78701 | Ph: 512.473.2140 | Fax: 512.473.8228 www.onestarfoundation.org