Community Service Certificate Request

Youth Initiatives

The Texas School Safety Center is pleased to provide students and student groups in 6th-12th grade an opportunity to request community service certificates for organizing projects/events or volunteering their time to help create safe and healthy schools and communities.

Please complete the form below to request a certificate for yourself or multiple certificates for a student group. If you have any questions about the form, please contact staff at txssc_yi@txstate.edu

Type of Certificate

Are you requesting a certificate for yourself or for a student group? Select the option below for the type of certificate you are requesting.

I am requesting a certificate for myself

I am requesting certificates for a student group

Type of Community Service

Creating Safer Environments. (Examples can include school cleanup drives, tobacco and vape litter pickups, assisting with school maintenance projects, National Night Out, disaster relief, emergency preparedness training, school safety training)

Promoting Healthy Behaviors. (Examples can include mentorship programs, prevention campaigns, schoolwide presentations and events)

Providing Resources. (Examples can include emergency preparedness donation drives, volunteering at local shelters or hospitals, blood drives)

Select the category your community service fits within:

Creating Safer Environments

Promoting Healthy Behaviors

Providing Resources

Details of Community Service

Project/Event Name:

If applicable, provide the name of the community service project or event.

School/Organizer Name:

Provide the name of the school or organization who hosted the project/event or coordinated your volunteering.

Location:

Where did your community service take place?

Date(s):

What date(s) did your community service occur?

Start Time:

What time did your community service start?

End Time:

What time did your community service end?

Purpose:

In a couple of sentences, share with us the purpose of the project/event or the purpose of your volunteering.

Role(s):

In a couple of sentences, share about your/your groups role(s) and responsibilities.

Reflection Questions

Please complete the following questions. If you are requesting certificates for a student group, the students can respond to each question as a group.

Question 1: How did your community service help others, and what did you learn about your school/community or the people in it?

Question 2: What was something hard or unexpected during your service, and what did you learn about yourself by dealing with it?

Contact Information

First Name:

Last Name:

Type:

Grade:

If applicable

Email:

Please provide a reliable email address so staff can follow up with you.

Please double-check all the information you provided is accurate. Once you submit your request, staff will review your submission and reach out to you through email to request any additional information and names of the individuals receiving community service hours.

Email:

Please ensure all required fields are complete before clicking Submit.