Douglas Anderson Verification of Community Service 2015-2016

Bright Futures Program and Silver Cord Revised 8/24/2015

To avoid disappointment please be sure to get your projects pre-approved

C/O 2016: To qualify for Bright Futures Scholarship, you must submit your hours by Graduation, 2016.
To qualify for Silver Cord, you must submit your application with hours earned to date to your history teacher by November 2, 2015 and
your remaining hours earned for the year by April 1, 2016. *MAKE A COPY OF THIS SHEET FOR YOUR RECORDS PRIOR TO TURNING IN
Student Name (Please Print)

________Student Number

Total # of Hours listed below __________

Date turned in_________

Date of
PreApproval

____Current Grade_____9th gr. entry year________

Type of

Service

# of

Club/Organization/

Volunteer Work

Site of Volunteer

(Please Print)

m/d/year

Hours

Non-Profit affiliation

(activity or task

Work

Name of Verifier

(Beg-End)

Verifiers Signature

Verifiers
Phone Number

performed)

PLEASE REMEMBER THAT ALL BLANKS ARE TO BE FILLED IN AND VERIFIED AND THAT NUMBER OF HOURS ARE TO BE TOTALED.
See back for more important information!