Volunteer Confirmation Form
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1VOLUNTEER CONFIRMATION FORM
Return this form to the Outreach Room after volunteering (white copy to Outreach room/yellow copy for student)
Students should keep a copy for their own records
STUDENT INFORMATION
Name: __________________________ GRADE_____ Phone ________________ E-mail________________________________
Check one or more: Outreach ______ Key Club _____ NHS ______NHS Event______Health ______ ELL ______ Other ______
EVENT INFORMATION
Agency Name & Event Title:________________________________________________________________________________
Description of Volunteer Work:_______________________________________________________________________________
Day & Date: ___________________________________________ Time: ___________________________________________
LEADER/HOST INFORMATION
Leader/Host Name: __________________________________
Date: ___________________ Total # of Hours: ___________
Leader/Host Phone # __________________________________ Leader/Host Email: ___________________________________
Leader/Host Signature: __________________________________________ Did Student Perform Expected Duties? YES
NO
All Volunteer Hours are subject to verification.
VOLUNTEER CONFIRMATION FORM
Return this form to the Outreach Room after volunteering (white copy to Outreach room/yellow copy for student)
Students should keep a copy for their own records
STUDENT INFORMATION
Name: __________________________ GRADE_____ Phone ________________ E-mail________________________________
Check one or more: Outreach ______ Key Club _____ NHS ______NHS Event______Health ______ ELL ______ Other ______
EVENT INFORMATION
Agency Name & Event Title:________________________________________________________________________________
Description of Volunteer Work:_______________________________________________________________________________
Day & Date: ___________________________________________ Time: ___________________________________________
LEADER/HOST INFORMATION
Leader/Host Name: __________________________________
Date: ___________________ Total # of Hours: ___________
Leader/Host Phone # __________________________________ Leader/Host Email: ___________________________________
Leader/Host Signature: __________________________________________ Did Student Perform Expected Duties? YES
NO
All Volunteer Hours are subject to verification.
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Parent category: Life