Completion of Hours Verification Form (Agency)

Community Service Verification Activity:Date:Location:Beneficiary (Name of Charity, Etc.):Beneficiary Contact Person: _____________________Title:_______________________Phone Number of Beneficiary Contact Person:Description of Work Performed:_____________________________________________________________________________________________________________________Hours in Isla Vista: Yes / NoAttach Verification Letter or E-mailMember’s NameNumber of Hours Completed1.2.3.4.5.6.7.8.9.10.Total Number of Members thatTotal Number of Hours Members Volunteered: __________ Volunteered: __________NOTE TO AGENCY MEMBER: By signing this form, you are verifying that the above number of hours and amount of volunteers indicated are correct. Signature: ___________________________________________***You will need to make multiple copies of this form for your members to take with them to each service event that they attend*** ................
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