verification Form

This is the official service hours verification form.  Hours recorded on any other form (with the exception of  organizations that will only sign their forms) will not be recorded.  

Make sure that you fill out the form in its entirety before submitting it.  If any areas are not filled out, your hours will be denied. 

Please print this form as necessary.  If you are completing hours from different organizations, each organization will need its own form to track hours.