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Douglas Anderson Verification of Community Service 2016-2017

Bright Futures Program and Silver Cord Revised 9/7/16

To avoid disappointment please be sure to get your projects pre-approved


C/O 2017: To qualify for Bright Futures Scholarship, you must submit your hours by Graduation, 2017.
Seniors wanting to pursue a Silver Cord must have all 200 approved community service hours submitted to the School Counseling Office
or Media Center by Monday April 3, 2017
*MAKE A COPY OF THIS SHEET FOR YOUR RECORDS PRIOR TO TURNING IN
Student Name (Please Print)

________Student Number

Total # of Hours listed below __________

Date turned in_________

Date of

____Current Grade_____9th gr. entry year________

Type of

Pre-

Service

# of

Club/Organization/

Volunteer Work

Site of Volunteer

(Please Print)

Approval

m/d/year

Hours

Non-Profit affiliation

(activity or task

Work

Name of Verifier

(Beg-End)

Verifiers Signature

Verifiers
Phone Number

performed)

PLEASE REMEMBER THAT ALL BLANKS ARE TO BE FILLED IN AND VERIFIED AND THAT NUMBER OF HOURS ARE TO BE TOTALED.
See back for more important information!