Service Request Form

60th Anniversary
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60 Acts of Service
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Service Request Form

Thank you for helping us celebrate Herkimer County Community College’s 60th Anniversary through service!

As part of our 60 Acts of Service initiative, we’re seeking opportunities for our students, faculty, and staff to give back throughout Herkimer County. If your organization has a volunteer project or service need between March 2026 and November 2026, please complete the form below.

Organization Name ^*

Address ^*

City ^*

State ^*

Zip ^*

Website or Social Media (if applicable)

Project Title ^*

Brief Description of the Project or Service Need ^*

Preferred Date(s) or Timeframe ^*

Location of Project ^*

Is this project part of a larger event or campaign? ^*

Yes

Approximate Time Commitment ^*

Preferred Group Size ^*

Small (3-5)

Medium (6-15)

Large (16+)

Flexible

Skills or Special Requirements (if any) ^*

Are there any age restrictions, safety requirements, or supplies needed? ^*

Yes

Expected Outcome ^*

Your Name ^*

Title/Role ^*

Phone Number ^*

Email Address ^*

By submitting this form, you confirm that:

The project provides a safe and inclusive environment for volunteers.
The project will not promote or endorse political or for-profit interests.
Your organization is willing to have photos and videos taken of the project.
Your organization is willing to have the project completion details publicized, including photos.
Your organization will provide appropriate supervision and/or orientation for volunteers.

All requests are subject to review and approval. Submission of this form does not ensure project acceptance or fulfillment.