Service Activity Form PLEASE USE THIS FORM TO DOCUMENT SERVICE ACTIVITIES Instructions: ● ● ●
Complete all sections of the form, including the full name of organization and contact information; Have the activity supervisor sign the form where indicated; Submit the form to the Honors Office by mail, fax, or in person. The Honors office is located on the West Campus, room 136. PLEASE SUBMIT FORMS PRIOR TO TERM DEADLINE. Mail forms to: Honors at Valencia (MC 4-16) 1800 S. Kirkman Road Orlando, FL 32811
Fax forms to: 407-582-1671 Email forms to: honors@valenciacollege.edu
STUDENT INFORMATION Name:
V-number:
Phone:
Atlas e-mail:
SERVICE ORGANIZATION INFORMATION
Name of Organization:
Name of Contact Person:
Phone:
e-mail:
Date(s) of Activity:
# of Volunteer Hours Worked:
Signature of Activity Supervisor
Date
Printed Name
OFFICE USE ONLY: Date recorded in database: Date confirmation email sent:
Tel: 407-582-1729
www.valenciacollege.edu.edu/honors
Fax: 407-582-1671
08 September 2011