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KEY CLUB PFHS VERIFICATION FORM

KEY CLUB PFHS VERIFICATION FORM
(Click here for the Printable .pdf form)

Student Name:                                                                                                               ___          Academic Year:  2018-19

Program Advisors:  Dawn Willis & Liauna Jordan

Name of Organization:                                                                                                                                                                 

Contact Person/Title:                                                                                                                                                                    

Date(s) of Service:                                                                                                           Total # of Hours:                              

Describe the nature of your community service:                                                                                                                         

                                                                                                                                                                                                               

                                                                                                                                                                                                               

Contact person/service supervisor’s signature

Confirming the amount of service conducted:

                                                                                                                     Date:                                                                    

Student’s signature verifying all information submitted is correct:

                                                                                                                                Date:                                                                    

.........................................................................................................................................
Published by Barbara Ratledge on August 22, 2018
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