Page 1 of 1   If you are an Old Westbury club planning a future community service or fundraising activity, fill out this form to have the event approved by the Community Service Center and Campus Life. If you are raising money for your own club, you need not complete this form.   1. Who are you? * First and Last Name       2. How can we reach you?* NYIT Email Address:       3. Student ID #: *Required*       4. If you are doing this service as part of a student club or organization, enter the club/organization name here:       5. What organization are you volunteering or fund raising for?* For ex: Meals on Wheels   Name:   Address:   City, State:       6. Who is your contact at the organization?*   Name:   Phone:   Email:       7. Type of volunteer service provided:* Ex: Held a fundraiser; wrote letters to lonely senior citizens, delivered meals to seniors in Chelsea       8. When will you be volunteering or fundraising?* Please provide the date(s).       9. How many hours do you plan to volunteer?*       10. If you are fundraising, what is your fundraising goal in dollars? (Write 0 if not fundraising.)*       11. If you are volunteering, how did you hear about the volunteer opportunity?   Career Net Community Service Center OW Community Service Center MA NYIT Club, Organization, Fraternity or Sorority Faculty or Staff Other, please specify

Community Service Center contact information:
Old Westbury Campus:  Phone: 516.686.4025/ Fax:516.686.7508
Manhattan Campus: Phone: 212.261.1690/ Fax: 212.261.1758

www.nyit.edu/csc