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* Indicates required question
Name
*
Your answer
Number of Hours
*
Your answer
Name of Service
*
Your answer
I guarantee that these service hours are unpaid and will not be used for other service obligations (NHS, Senior Social Studies, etc.)
*
Yes, my service hours meet the stated requirements
Name and title of individual in charge of this service project: (If this is an event promoted through our club, simply put in Mrs. Jackson's name.)
*
Mrs. Jackson
Other:
Contact information (phone or email) of individual in charge of any OUTSIDE service project: Can only have 10 outside hours!
Your answer
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