
1st
Semester 22 hours required/2nd
Semester 14 hours required
_____________________________________ _____________________
Student’s Name Date
The above named student has completed _______ hours of volunteer/community service and should receive credit for the following:
(Describe job, duties, work completed, etc.)
(Signature cannot be a parent or relative.)
________________________
Verifying Signature
______________________________________________________________
Address
_________________________
Phone Number