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Involvement Hours 2016-17

Teens Name:__________________________________________________
Grade____ Date of Event: ___________ Total Hours_________
Attended Event
Parish

Service Performed
Community

Description of Event
_______________________________________________________________

(Work done for family members or for a Profit business are not considered
Involvement Hours)

Printed Name of Event


Coordinator/Director________________________________________________________
Event Coordinator/Director Signature
_________________________________________________Phone___________________
**Please fill out forms COMPLETELY and submit them within 90 days of service to
Jodi Moss.**

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