Presidential Volunteer Service Award Form

2023 Presidential Volunteer Service Award Form

Please use this form to order 2023 Presidential Volunteer Service Awards. After completing this form, YVCHQ will send you an invoice to pay for your award packages. Total is in US dollars. If you have additional questions or concerns, please email Danette Seffens at dseffens@yvc.org

Please select your affiliate from the menu below.*
Program Director Name*
First Last
Program Director Email*
Program Director Phone*
Address*
Please enter the address where you'd like the Presidential Volunteer Service Awards to be shipped to.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Please list any youth who are eligible for a Presidential Volunteer Service Award.*
List each youth volunteer's first and last name, their email address, age, total service hours during the most recently completed program year (NOT their cumulative hours since their start at YVC), and their award level.

Youth ages 11-15 can be eligible for the following award levels: bronze (50-74 hours), silver (75-99 hours), and gold (100+ hours).

Youth ages 16-18 can be eligible for the following award levels: bronze (100-174 hours), silver (175-249 hours), and gold (250+ hours).

Please make the format look like the example below:

Sally Smith, ssmith123@gmail.com, age 16, 120 hours, bronze

Jake Brown, jbrown456@gmail.com, age 12, 100 hours, gold
Citizenship and Service Verification*
Only U.S. citizens or lawful permanent residents of the U.S, (green card holders) are eligible for the Presidential Volunteer Service Award. Service hours completed for court-ordered community service do not count for the PVSA. Check the box below if the statement is true.
- The youth volunteers listed above are all U.S. citizens or lawful permanent residents of the U.S., and their service hours listed above were not for court-ordered community service.
Certificate only (signed by the U.S. President) Quantity*
Price: $5.00
Certificate + Pin Quantity*
Price: $6.50
Certificate + Coin Quantity*
Price: $10.50
Certificate + Medallion Quantity*
Price: $10.50
Shipping*
Price:
If you are ordering various award packages, please note which packages are for which award categories. (Put N/A if you're only ordering one type of award package.)
i.e. Are certificate-only packages only for bronze award recipients? Are certificate + pin packages only for silver award recipients?
Total
$0.00

Save and Continue Later