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Confirmation Service Hours
Please complete this form for each service activity.
Email address *
Name
Your answer
Date of Service *
MM
/
DD
/
YYYY
Hours Served *
Hrs
:
Min
:
Sec
Location of Service *
Your answer
Description of Service *
Your answer
Supervisor Name *
Your answer
Supervisor Contact Number *
(440)###-####
Your answer
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