Student Community Service-Volunteer Hours Confirmation Form

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South Texas College - Dual Enrollment Academy Programs
Community Service-Volunteer Hours
Confirmation Form
Thank you for allowing our students the opportunity to enrich their lives with your
organization.
To be filled out by the organization:
Individual/Organization Name: ____________________________________________________
Address of organization: _________________________________________________________
Student Name: ______________________________ Grade: _____________________________
Service Activity: ________________________________________________________________
Contact Person/Supervisor: _______________________________________________________
Title: _________________________
Contact Number: ______________________________
Dates of Service: ________________
Hours of service provided by student: __________
Brief description of service: _______________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
I certify that this student has completed the service hours recorded above towards their
service learning requirement.
Signed: _________________________________
Date: __________________
South Texas College - Dual Enrollment Academy Programs
Community Service-Volunteer Hours
Confirmation Form
Thank you for allowing our students the opportunity to enrich their lives with your
organization.
To be filled out by the organization:
Individual/Organization Name: ____________________________________________________
Address of organization: _________________________________________________________
Student Name: ______________________________ Grade: _____________________________
Service Activity: ________________________________________________________________
Contact Person/Supervisor: _______________________________________________________
Title: _________________________
Contact Number: ______________________________
Dates of Service: ________________
Hours of service provided by student: __________
Brief description of service: _______________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
I certify that this student has completed the service hours recorded above towards their
service learning requirement.
Signed: _________________________________
Date: __________________
To be filled out by the student:
Why did you select this activity and organization?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
What did you learn from this experience?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Will you return to this organization again? Why or why not?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Student Signature: ______________________________________________
Date: ________
Parent Signature: _______________________________________________
Date: ________

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