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Cupertino High School National Honor Society 2009-2010 (info.tinonhs@gmail.com)

VERIFICATION SHEET

For outside & regular (once a month or more) service to the community Member Name (First & Last): ___________________________________________________________________ Phone Number: ____________________________ Email Address: ____________________________________ Name of Service Organization: _________________________________________________________________ Type of Volunteering (please briefly describe): _____________________________________________________ __________________________________________________________________________________________ Time Donated to Above Organization (be specific- hours a week, weeks per month, months/year): ___________ __________________________________________________________________________________________

-------------------------------- PART BELOW TO BE FILLED OUT BY OFFICIAL CONTACT PERSON -------------------------------Name of Official Contact Person at Above Organization: _____________________________________________ Contact Phone Number: _______________________ OFFICIAL Email Address: ___________________________

I certify that ______________________ (student’s name) has completed this service to the organization I represent exactly as outlined in the time window described above, and that he/she has done so while working towards the ideals of leadership, scholarship, character and service that the Society upholds. _______________________________________ Official Signature

________________________ Date


Verification Sheet