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Service Hours Submission Form

Name: Grade: School Year:


A minimum of 20 hours are required each school. Up to 10 hours will rollover to the following school year if 20 hours are exceeded.
Date Volunteer Event or Nonprofit Organization Number Duties Performed Verified by (Advisor,
of Hours Volunteer Leader, or Agency
Contact)

Totals Hours Earned: Advisor Signature:


Date:

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