Free community service form 44
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Confirmation of Community Service Form

Please note that there is to be only one community service project per form.

I,
in accordance with the
Jack and Jill of America Foundation’s scholarship eligibility requirements, verify that I performed the following community
ser- vice project. (*See description for “active” community service):

Name of Organization

Address

City, State, Zip Code

Name of Project

Briefly describe the service project/duties:

Hours of Service Performed

Signature of Supervisor

Supervisor’s Title

Telephone Number

Student Social Security Number

Student Name (Print)

Student Signature & Date

This form certifies that the above named project was performed within the time frame outlined in the scholarship application.