President's Volunteer Service Award - Hack+ Request Form

Hack+ is a President's Volunteer Service Award (PVSA) certifying organization. Read more about the PVSA here: https://presidentialserviceawards.gov/ This form should be filled out by an individual who can certify that the recipient has reached the designated number of volunteer hours. NOTE: your project must have enough balance on Dash to pay for the fees associated with the PVSA, including shipping fees. Fees are listed below.

Recipient First Name

Recipient Last Name

Hack+ Email of Recipient

Personal Email of Recipient

Age Group of Recipient

Total Service Hours of Recipient

(in the last 12 months only)

Log of Service Hours

(in the last 12 months only) For each activity, you must include "Date", "Start Time", "End Time", "Hours Volunteered", "Description of Volunteering Service", and "Supervisor".

Attach file

Drop files here

Award Type

These fees will be deducted from your Dash balance. For more information, see here: https://presidentialserviceawards.gov/award-packages You will also be charged for shipping. The total cost for each award is generally $20-30 per award, including shipping.

Address Line 1

If you are submitting multiple awards for a project, use the same address across your submissions to save on shipping costs.

Address Line 2

City

State

ZIP Code

Full Name of Supervisor

Email of Supervisor

Organization Name

This should be the name of the fiscally-sponsored organization on Dash.

I swear, under penalty of perjury, that the person filling out this form is the Supervisor listed above.

I swear, under penalty of perjury, that the Recipient listed is a United States citizen or lawful permanent resident of the United States.

I swear, under penalty of perjury, that the Recipient listed is not a registered sex offender in the United States.

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