St. Stephen's Community Service Hours…

               St. Stephen's Community Service
              Hours Verification Form 2008-2009
                     This form MUST be turned in, complete,
                     within two weeks of the date of service.
                            All information is required.
     Please turn in completed forms to the pink folder in the crossroads area.

First and Last Name ______________________________________________

Grade        9     10     11    12    (circle one)

Name of Project _________________________________________

Date of Project _____/_______/200___*must be between 5/24/08 and 5/22/09

Number of Hours Volunteered _________

On      or   Off   campus       (circle one)

Brief Description of Service Performed

__________________________________________________________________

Name of Supervisor ___________________________________                 (please print)


Supervisor's phone Number     (_____)- _______ - ___________
    or
E-Mail Address      _________________________

Supervisor's Signature          ___________________________________




                                                     Office use only: ______________
                                                                      ______________