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Service Learning (8.5 x 11 in) (1)

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vibha.mudaliar
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10 views

Service Learning (8.5 x 11 in) (1)

Uploaded by

vibha.mudaliar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Service Hours Verification Form

Directions:
Hours must be completed with a nonprofit organization.
Irvington High School
Use a separate service learning form for different organizations.
Keep all completed service documents for your own record until you graduate.
Please print neatly and have all sections and signatures completed to receive credit for your service.
IHS
Contact email must be current so hours can be verified, if not, hours will not be counted.
Se
r vice
ALL SIGNATURES MUST BE INK SIGNATURES.
ALL HOURS MUST BE DOCUMENTED IN THE SERVICE HOURS TRACKING SECTION OF THIS FORM
(no more than 8 hours a day will be accepted).

Student's Name (as it appears on your transcript): ________________________________________ Student ID#: ___________ Graduation year: _______

Category (check one): Educational Environmental Humanitarian Benchmark __________________________


Contribution (what tasks did you perform during service)
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
Impact (what difference did you make)
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________

Service Hour Tracking


Only complete logs with a supervisor's signature will be accepted. Signatures must be in INK.
If you need more space, continue on the tracker on the back.

Date Times Hours Served Signature of Supervisor

Example Example Example


Saturday, 10/20/2022 9:00 am - 12:00 pm 3 hours

Total hours* _____________

Completed by Supervisor
Please do not verify and sign unless ALL the information is filled out above and hour tracking is completed.

Date(s) of Service: ________________________________________________________________________ Total Hours* (see above): _______________


Organization Information
Name of NON-PROFIT Organization: _____________________________________________________________________________________________
Address:__________________________________________________________________________________________________________________________
Email:_________________________________ Website: _____________________________________________________EIN #: ______________________
Supervisor Information
Name: ____________________________________________ Signature: __________________________ Contact Number: (_______)_____________
Use this page if you need more space to track your hours. Submit both sides when turning it in.

Date Times Hours Served Signature of Supervisor

Example Example Example


Saturday, 10/20/2022 9:00 am - 12:00 pm 3 hours

Total hours* _____________

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