Intern Community Service Verification Form - Inroads
-342900-619125Intern Community Service Verification FormALL COMMUNITY SERVICE MUST BE UNPAID AND VOLUNTEER WORKIntern and Agency/Organization InformationIntern Name:INROADS Advisor:Agency Name:Agency Phone:Agency AddressAgency Contact:InstructionsDates and hours served at agency/organization (please include month, day, and year)DateActivityNumber of HoursAgency Verification (initial)Total hours served at this agency: _________Starting date of service at this agency:________Ending date of service at this agency: __________Signature of Site Manager or Agency/Organization Representative: XForm must have authorized signature of agency representativePrint Name and Title: ___________________________________________________________ ................
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