City of Victoria Form Center

2. Name of Agency or Organization*
3. Contact Person Name *
   Name of contact to set up community service
5. Address*
7. City*
8. State*
9. Zip Code*
11. Phone Number*
12. E-mail Address*
14. Minimum Age Requirement*
15. Requirements for minors (Under 18)*
    Minimum Age Requirement
16. For minors (under 18), Is parent/guardian required? *

    1. Yes, Parent/Guardian Required
    2. No, Parent/Guardian Not Required
    3. N/A all volunteers must be 18 or older
18. Any offense/violation restrictions*
    i.e.: Theft, violent crimes, etc.
20. Contact information
    Please fill out the below information to include: who should someone contact for community service and the best contact for verification.
22. Full Name*
    Include First and Last Name of person to verify community service hours
23. Full Name (Alternative Contact)*
    Include First and Last Name of alternative contact to verify community service hours
25. Phone Number*
26. Fax Number*
28. Email Address*
30. General Community Service Information
    Please fill out duties or tasks performed, hours of operation, and any additional pertinent information.
32. Duties or Tasks performed*
    Detail Types of duties or tasks performed
34. Hours of Operation*
    To include general hours of operation as well as volunteer hours if different from hours of operation, or minimum length of time someone can volunteer (example minimum of 2 hours)
36. Any additional information*
    Please include any additional information you feel is important such as: training requirements or application process.
38. Documentation Upload
    Please include any additional information you feel is important to share with the court such as flyers regarding your services, waiver forms, or applications.
39. Documentation Upload
    Please include any additional information you feel is important to share with the court such as flyers regarding your services, waiver forms, or applications.
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit

* indicates a required field