Application for Community Service

Name(Required)
MM slash DD slash YYYY
Gender(Required)
Address(Required)

Emergency Contact

Name(Required)

Community Service Information

Probation Office Address(Required)

Community Service Period

Availability

(Please list the hours you are available. Use N/A to indicate the day(s) you will not be available. Note: Community service hours are to be completed Monday through Friday, during regular business hours. Weekend or alternative hours must be approved by an administrator.

Code of Conduct - Community Service

Please read each section carefully and initial in the space provided. Check that you understand and agree to abide by the rules, regulations, and responsibilities as a community service participant with NAMI Central Georgia, Inc.(Required)

Responsibility

As a community service participant at NAMI Central Georgia, Inc. I understand that all matters concerning residents, staff, and other consumers are completely confidential. I also agree to follow NAMI Central Georgia, Inc. guidelines, rules, & regulations.
Name(Required)
MM slash DD slash YYYY
I have read and understand the code of conduct for community service participants. I pledge to maintain a level of professionalism during the completion of my community service hours