Request for individual certificates for YouthMappers

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Please use this form to request a digital copy of a certificate that you may print out and use. We process these requests monthly, so please allow up to four weeks for a response. Your request will be validated and checked for verification before being sent to the email address you provide below. You will NOT receive a hard copy print out request.

For bulk requests, please choose "other" for the type of certificate and explain your request in the comments at the end. Then please send a spreadsheet of names and OSM usernames to info@youthmappers.org of the set of recipients.

Email *

Email address used to access YouthMappers Google Group

Which type of certificate is this request for? *

Individual Membership Certificate (to be verified by chapter officers; please provide dates below in "other" field)

Faculty Mentor / Advisor Certificate (to be verified by chapter submission or annual report)

Let Girls Map Certificate (verification by use of hashtag by OSM username provided)

Appreciation to a Community Partner (full name field should indicate the name of the organization or high school, etc. not a person)

Recognition of Service Hours (please add the number of hours below in "other")

Other:

FULL NAME exactly as it should appear on the certificate (case sensitive) *

Name of the person making this request *

OSM username of the individual to whom the certificate will be issued *

Role of the individual to whom the certificate will be issued *

Student YouthMapper member of a chapter (list date of graduation below)

Faculty / mentor of YouthMappers chapter (list dates of service below)

Organizer of the activity to be certified (list dates of the activity or event below)

Required

Please list the dates of activity, e.g. date of graduation, dates of service, events, etc. *

Gender of the individual to whom the certificate will be issued *

Female

Male

Prefer not to say

Other:

Name of the university where the chapter of YouthMappers is affiliated *

City, State/Province, COUNTRY *

In what format do you wish to receive the digital certificate for printing? (color is default) *

Black and White / Grayscale mode

Color format

Do you have a profile on LinkedIn?

Yes

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Other comments

Send me a copy of my responses.

Submit

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