Community Service Verification Form printable pdf download

Community Service Verification Form

COMMUNITY SERVICE VERIFICATION FORM

RETURN TO:

WAUBONSIE VALLEY HIGH SCHOOL

2590 Ogden Avenue | Aurora, IL 60504

STUDENT NAME:

GRADUATION YEAR:

This is to certify that ___________________________, a student at Waubonsie Valley

High School, has completed __________ unpaid hours of service to me (our agency).

Dates the service occurred: __________________________

His/her duties involved the following responsibilities:

My/our evaluation of the following qualities of this student's service are:

EXCELLENT

GOOD

FAIR

NEEDS IMPRVMNT

ATTITUDE

PUNCTUALITY

ASSUMING

RESPONSIBILTY

PERFORMANCE

NAME (or Agency Name): ____________________________________________________

ADDRESS: ________________________________________________________________

_________________________________________________________________________

SIGNATURE OF PERSON REPORTING

POSITION OR TITLE

TELEPHONE# WHERE YOU CAN BE REACHED FOR VERIFICATION: _____________________

Additional Comments may be written on the reversed side of this sheet.

Thank you for your support of community service.

Mrs. Kristine Marchiando- Principal

Updated 01/10

Community Service Verification Form