National Honor Society Application Form Page 4
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4Service Verification Form – Final Tally Sheet
*Please see the application packet for specific requirements*
Name: _____________________________________
TOTAL HOURS
Please combine all hours with the same group / agency and supervisor. Attach service log sheets with signatures if necessary.
All information must be completed in ink.
Group or Agency
Type of Service Performed
# of Hours
Printed Name of Supervisor and Signature
Phone # of Supervisor
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