CRA/ROOTS Community Engagement Submission Form THIS IS A TEST FORM

Step 1 of 7

14%

Date of Event

MM slash DD slash YYYY

Market or Specific Location?(Required)

Branch?

Beaver Trail

Broadway

Cave City

Edmonton

Happy Valley

Park City

Somerset

Branch?

Tompkinsville Main

Highway 163

Fountain Run

Scottsville

Branch?

Campbell Ln

Franklin

Greenwood

Lehman Ave.

Louisville Rd

Nashville Rd

Branch?

Carter Rd

Frederica St

Highway 54

Branch?

North Dixie

Ring Rd

Branch?

Clarksville

Murfreesboro

Branch?

Logan Plaza

Branch?

Brownsboro Rd

Branch?

Waller Ave

Branch?

Operations Center

Name(Required)

First Last

Community Involvement Activity.(Required)

Attend Community Event / Ribbon Cutting

Attend Bank Sponsored Event

Member of a Service Organization

Teach a Financial Literacy Class

Organize Community Event

Media Recognition (Radio, TV, Social Media) Media Recognition (Radio, TV, Social Media)

Please confirm the Community Involvement Activity.(Required)

Attend Community Event / Ribbon Cutting

Attend Bank Sponsored Event

Member of a Service Organization

Teach a Financial Literacy Class

Organize Community Event

Media Recognition (Radio, TV, Social Media)

Name of Event(Required)

Number of hours for the Event?(Required)

Name of Organization(Required)

Role in Organization (Member, Officer, Board Member)(Required)

Meeting Hours (Weekly/Monthly)(Required)

Number of hours for planning monthly?(Required)

Organization served(Required)

Topic(s)/Program covered (e.g. How to make a budget, How to open a checking account, Junior Achievement, 4H, etc)(Required)

Audience (e.g. 2nd graders, First Time Homeowners)(Required)

Number of participants for the activity?(Required)

Media recognition (radio,print,social media,TV)(Required)

If applicable, Provide any additional details or information about the activity.

Select the option below that is the number Forty-One.

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First Choice

Second Choice

Third Choice