CRA/ROOTS Community Engagement Submission Form

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Date

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 a Community Event/Meeting

Attend a Ribbon Cutting

Member of Service Organization

Participate in a Community Event or Teach a Financial Literacy Class

Media Recognition (Radio, TV, Social Media)

Organize Community Event

Please confirm the Community Involvement Activity.(Required)

Attend a Community Event/Meeting

Attend a Ribbon Cutting

Member of Service Organization

Participate in a Community Event or Teach a Financial Literacy Class

Media Recognition (Radio, TV, Social Media)

Organize Community Event

Organization Served (e.g. ABC Elementary School, Habitat for Humanity)

Role with the organization?

Volunteer hours for calendar year?

Organization Served (e.g. ABC Elementary School, Habitat for Humanity)

Supporting Organization (Junior Achievement, 4H, etc)

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

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

Number of participants for the activity?

Number of hours for the activity?(Required)

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

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