Community Service Hours Form

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Student Number:
Year of Graduation:
Student Name:
Total Hours:
Date(s) service completed:
Volunteer work performing the following tasks:
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______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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Name/Address of Organization: ________________________________________
________________________________________
________________________________________
Supervisor’s Name & Signature: ________________________________________
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Title: ____________________________________________________________________
Phone Number: _________________________________________________________
Date: ____________________________________
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