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Submission of Outside Service Hours
** All eligible hours must be submitted to the Literacy Center by the end of the qualifying calendar year **
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** Most voluntary service is eligible, with the following exceptions: political lobbying, religious instruction, conducting worship service, proselytizing, and serving only family members. Non-partisan voter registration is an eligible activity. **
Volunteer Name *
Phone Number *
Date of Birth *
MM
/
DD
/
YYYY
Age Category *
Required
Date(s) of Service *
Place of Service *
Contact Person and Phone Number *
Number of Hours *
Approved By (Office Use Only)
Date (Office Use Only)
MM
/
DD
/
YYYY
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