Palo Alto High School President’s Service Award Application Form Requirement: 100 hours of Community Service performed within 12 months Name
_____________________________________________
Grade _____________ Age_______________ Male___ Female___ Are your service hours part of a service learning program? _________ Service Classifications (check all that apply): __Healthy Communities
__ Public Safety & Emergency Response
__Parks and Open Spaces __ Youth Achievement
__ Other___________________________
Dates of Service: beginning_______________ ending ______________ Please attach a copy of your Community Service Verification Form Total Hours Served :
________
I certify that the above information is accurate. Student Signature: ________________________________________ Date: _______________