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President's Volunteer Service Award Request Form
Complete this form once you have completed the hours needed for your award level and you have emailed your Picky Eats Volunteer Logbook and all supporting documentation to
pvsa@pickyeats.org
.
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* Indicates required question
Email
*
Your email
PVSA Recipient First and Last Name
*
Your answer
PVSA Recipient Phone Number
*
Your answer
PVSA Recipient Mailing Address ( Where the award certificate will be sent to )
*
Your answer
PVSA Recipient Date of Birth (required by PVSA)
*
MM
/
DD
/
YYYY
Indicate which year you wish for hours to be reviewed. Enter the 1st and last date of service to be considered. For example, Year 2021 : 3/1/2020 - 3/1/2021
*
Your answer
Number of Service Hours Earned for this time period
*
Your answer
Parent / Guardian Name
*
Your answer
Parent / Guardian Email
*
Your answer
School Attending (full name of school)
*
Your answer
Grade in School
*
Your answer
Information must be submitted through this form prior to consideration for the PVSA
*
I understand
Required
Thank you for answering!
Thank you for filling out this form. I will contact you back soon in regards to catering out group dinner.
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