PRE-CAS Volunteer Verification Form

Directions on how to complete this form, and how to have PRE-CAS SERVICE hours recognized by
BWYA, are included on the reverse side of this form.

Please use one PRE-CAS Volunteer Verification Form per experience

Student name: ____________________________________________Tom__________________________________________________________

Name of Organization or Center: ___________BWYA Club____________________________Org. Phone

#______________________________________

Organization Address: ________________________________________________________________________________________________

Name of Site Manager/Supervisor: _____Ms.Veronica Ho

_________________________________________________________________________________

Service in Need Identified: ______people can learn how to deal with interpersonal relationships and control your own emotions through our help
_______________________________________________________________________________________

Description of Task Performed to Meet the Need: _____In the club we will teach them psychology facts and help them by case study, we
also needs to know how to do a Psychological consultation and case
report______________________________________________________________________

____________________________________________________________________________________________________________________

Dates and Hours Served (please include day, month and year)

Starting Date Avtivity Ending Date Hours Supervisor signature

210901 Confirmed our class outline/and made a class outline report and a 210901 3
poster to promote our club
 210909 Made a PPT to tell our club teachers our club outline( because I am the 210911 3.5
club leader ) and made a survey to investigate what does people like to
hear in this club

210913 Made a big poster for club fair and a short video for WB 210913 3

210920 Made a 1000+ words investigation report for a case study 210921 2

210921 Made a PPT for our first class 210922 2

210923 Made a Excel workbook to record cases 210923 1

210925 Made a mind map for one of our cases 210926 1

Signature of Site Manager: __________________________________________________ SA Supervisor: ____________________ Date: _____________

Starting Date Avtivity Ending Date Hours Supervisor signature

Signature of Site Manager: __________________________________________________ SA Supervisor: ____________________ Date: _____________

Directions

1. Please print neatly.

2. Use one form per organization.
3. If your Pre-CAS Experience is done through a school service club, please use one form and have your club advisor/supervisor sign it.
4. You may copy this form.
5. Please fill in the entire form. When recording dates, please include day, month and year.Once you have completed your Pre-CAS Experience,
please upload this form as evidence for that experience.
6. Record all of your hours on these forms, have a supervisor at your service site sign the forms. Please don’t re-submit hours that have already
been submitted.
7. This form will provide addition support to your proposal on MB since it proves that you completed your service under supervision of either
an external, out of school, or internal, in school, supervisor
8. Keep this form in your portfolio
9. Write a reflection and attach it to this form

Work Well. Work Hard. Make it Memorable!