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Volunteer Hours for Independence High School: Volunteerism Diploma
Please submit this form each time you complete volunteer hours. Please be aware that volunteer hours may be verified at random. According to State guidelines, students who voluntarily complete at least 10 hours of community service in each semester the student is enrolled at a public school will receive recognition at graduation. WCS has chosen to recognize the Volunteerism Diploma with a designation in the graduation program. Ten hours each semester must be documented on this form, beginning with the 2017-2018 school year. Semester 1 of each school year runs from the time school begins in August until Winter Break. Semester 2 runs from the time we return from winter break until school is out for the summer. You MAY count activities performed for another organization.

Please note:
• Students cannot be paid to do volunteer work
• Volunteer work cannot be done for a family member
• The student is responsible for tracking volunteer hours and submitting them through our Volunteer Hours Form

First Name *
Your answer
Last Name *
Your answer
Year of Graduation *
Date of Volunteer Service *
MM
/
DD
/
YYYY
Number of hours completed *
Your answer
Description of the volunteer service *
Your answer
First and last name of person who supervised your volunteer service *
Your answer
Phone number of supervisor *
Your answer
Email address of supervisor *
Your answer
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