Silver Cord Application Form
Please fill out this information in order to apply for Silver Cord hours.  All questions must be complete as thoroughly as possible.  If there are any questions/concerns about the application process, please contact Mrs. Donald at ldonald@benton.k12.ia.us
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Email *
Student Last Name *
Student First Name *
Graduation Year *
Month/Date/Year of Service *
Beginning Time of Service *
Time
:
Ending Time of Service *
Time
:
Total hours volunteered *
Hrs
:
Min
:
Sec
Name of event or organization work was performed for. . . *
Activity performed (provide a description in complete sentences with proper grammar/capitalization) *
What did you learn while completing this volunteer experience? (provide a description in complete sentences with proper grammar/capitalization) *
How will this volunteer experience help you in the future? (provide a description in complete sentences with proper grammar/capitalization) *
Name of coordinator/supervisor at service site *
By providing this name, you are giving permission to contact this person to verify your work.  If this person cannot verify your work, hours will not be awarded.
Phone number of coordinator/supervisor *
Email address of coordinator/supervisor *
A copy of your responses will be emailed to the address you provided.
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