Silver Cord Approval Form
The Silver Cord Program is to encourage students to give back to the Belmond-Klemme community through volunteering. We want to make volunteering a year-round activity for students. This program helps students develop a sense of responsibility and pride in their town.  
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Name: *
Graduating Class of: *
Service Learning Opportunity (Provide a description of the activity and the location) *
Date *
MM
/
DD
/
YYYY
Total Number of Hours Completed *
Activity Coordinator (this person will be contacted by the school) *
Activity Coordinator's phone number. *
Activity Coordinator's Email
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