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
Submit
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