PGHS Community Service Prior Approval Form
Name *
Enter your name in normal First Name Last Name format (e.g. John Smith)
Your answer
ID Number *
Your answer
Advocacy Teacher (Last Name) *
Your answer
Email Address *
Double check to make sure that it is correct!!! This will be the address where your approval notice will be sent.
Your answer
Name of Professional Non-Profit Organization *
All community service must be through a community-based, professional, not-for-profit organization
Your answer
Name of Contact Person/Supervisor *
This needs to be the same person who will sign off on the verification that the service has been completed.
Your answer
Contact Person/Supervisor Phone # *
Failure to provide a valid contact number may result in your request not being approved.
Your answer
Description of Activity *
Describe BOTH the event you will be working at AND a description of the work you will be doing at that event.
Your answer
Date(s) of Expected Service *
Estimate date(s) if specific dates are not known.
Your answer
Estimated number of hours you expect to complete with this activity *
Your answer
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