Community Service Verification Form

Community service programs use this form to verify and certify the volunteer hours a student has completed.

Use this template

Student Name

First Name

Last Name

ID Number

Grade

School Name

Advisor Name

First Name

Last Name

Name of the Organization

Description of Community Service Work

Explain the purpose (mission statement) of the organization you served

How did (or will) your work benefit the community?

I, undersigned, agree with the following statement

I Agree

Parent/Guardian Name

First Name

Last Name

Date

Signature

Sign here

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