Are You suprised

Community Service hours
Student Number:
Year of Graduation:
Student Name:
Total Hours:
Date(s) service completed:
Volunteer work performing the following tasks:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Name/Address of Organization: ________________________________________
________________________________________
________________________________________
Supervisor’s Name & Signature: ________________________________________
________________________________________
Title: _____________________________________________________________________
Phone Number: ___________________________________________________________
Date: ____________________________________
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