Write hours in
ETHS COMMUNITY SERVICE
VERIFICATION FORM—for one time activities/events
IMPORTANT! INSTRUCTIONS: Fill out all sections of the form. If you do not follow the instructions, full credit for the hours may not
be recorded. Service must be performed at a non-profit- 501(c)(3) or public sector organization and cannot be religious in nature or
promote a specific political party or candidate as we are a public institution. If you have questions, please visit our ETHS website.
Using another paper with the same information as below is acceptable. DO NOT USE PENCIL or WHITE OUT. DO NOT CROSS OUT
YOUR HOURS OR DATES. TURN IN THIS AND ALL VERIFICATION FORMS TO THE ETHS COMMUNITY SERVICE OFFICE IN THE HUB.
TO BE COMPLETED BY STUDENT: (All information required in ink)
STUDENT VOLUNTEER NAME
NAME AND LOCATION OF AGENCY/ORGANIZATION
WHAT DID YOU DO WHILE VOLUNTEERING? (Be specific.)
TO BE COMPLETED BY SUPERVISOR: (Do not cross out dates or hours; do