Volunteer Hours Record Sheet

Indiana Master Watershed Steward Program

Use this form to track your volunteer service hours. A minimum of 35 hours of service is
required. Service must be to a local, county, state or federal natural resources agency or
organization to receive your Master Watershed Steward certificate of completion and be
eligible for the Mater Watershed pin and newsletter. Upon completion of your service hours,
mail or email this form to your class coordinator. For more information concerning volunteering times or
volunteer opportunities, contact Leslie Dorworth at (219) 989-2726 or email ldorwort@pnw.edu.

Your Name ______________________________ IMWS host site and year class taken____________________________________________

Address (number and street, city, state, and ZIP code) _________________________________________________________________________

Telephone number (home): ________________________ Cell Number: _________________________ Email Address: _____________________

Volunteer Activity Date Hours Agency/Organization Comments

(month/day/year) Signature of
Representative
Volunteer Activity Date Hours Agency/Organization Comments
(month/day/year) Signature of
Representative