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Event Verification Form

To verify service, please complete this form for each different event and submit with your portfolio.

Name of Event: (-t f or (o,,,nr,.n bt'^^ro

organization , ,{L.--, V {1.,r<u+,-,,L.zrn a* 5K


Type of Service' io\"lVi{
Describe your service activities:
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c,,5 ("ol.l. f -SLl r uq n^a r&Lr^a.):g"


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Purpose of Event:
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Date of servlce:
Ll ^-7- -.l(&tart
time: G : to End time: Io:to
Total Hours: 'l

Supervisor lnformation

Name: nebe .{L^$cr


Poshion: PraLs{ot
Phone:
OR
Email: 6i^t^r,to"e).t
Signature: {(,fl^+- Date

Student lnformation

Name: K"t, T.,qzl{


Signature:

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