100 Black Men of Greater Charlotte - Confirmation of Community Service Form
APPLICANT: Please arrange to have your community service confirmation (CSC) submitted on or before March 15, 2025. The CSC must be from community service personnel(s) and/or supervisors. CSCs must be submitted using this form. Letters are not acceptable in place of this form. Unacceptable CSCs will render the application incomplete. Such applications will not be given further consideration.

Only "active service" will be considered. Examples include: serving food to the homeless through a soup kitchen or shelter; tutoring students; picking up litter and recycling ; coordinating a community food/shelter drive; etc.

"Passive service" will not be considered.  Examples include: donating food/clothing in a clothing drive; babysitting; singing in a choir; serving as an officer in an official position of a church or civic organization; etc.

TO THE PERSON PROVIDING THE REFERENCE: Please complete the information below and provide your professional email address below (for confirmation purposes).  More information regarding the scholarship application is available at https://sites.google.com/uncc.edu/view/100application. The email address requested directly below should reflect your association with the organization being served.  Please do not provide a personal email address. Thank you.

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In accordance with the 100 Black Men of Greater Charlotte Inc., scholarship eligibility requirements, I verify that the applicant below performed the following community service project.

Applicant First Name
Applicant Last Name
Name of Organization
Address
Name of Project
Description of Project/Duties
Date(s) and Time(s) of Service
Total Service Hours Performed
Electronic Signature of Supervisor (First and Last Name)
Supervisor Title
Supervisor Telephone Number
A copy of your responses will be emailed to the address you provided.
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