Mt. Carmel High School: A.P. Government

Community Service Verification Sheet

To be filled out by Student:

Name of Student Volunteer______________________________ Date of Service  _________

Name of Non Profit Service Organization __________________________________________

Name of Non Profit Service Organization Representative _______________________________

Total Hours Volunteered ____________

Summary of activities participated in by student volunteer ______________________________

_____________________________________________________________________________

_____________________________________________________________________________

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To be filled out by the service organization representative:

Name of Representative __________________________ Title _______________ Date___________

Signature _____________________________________

Total Hours Served by Student Volunteer ______________________________