TO BE COMPLETED BY THE STUDENT:

Student Name _______Eric Zeng_____________

Students Grade level (Mandatory) ___G9______
Student Number _________________________
School Name ___Skyline High school in Washington State, USA________________________
Total Hours of Actual Service Given ___15 hours_______________
Date(s) and Actual Times Worked _______5 days_______________
Name of Organization ______Nanjing Childrens Social Welfare Home
Nature of Work (actual work performed)
Helping teacher , play and take care the small disable kids ,
____________________________________________________________________________
I certify that the information on this form is, to the best of my knowledge, truthfully reported and
in keeping with the high standards of integrity of Skyline High School.
Students signature ____________________________ Date ___________________________
TO BE COMPLETED BY THE ADULT SUPERVISOR/PROJECT CONTACT:
Adult Supervisors Name ____Xuan Haoyu_____________________________________
Position with agency/organization ______Manager____________________________
Actual # of hours the Student worked ____15 hours_____Verify with initials___XH__________
Evaluation of the students work or comments:
This students is very corporate and help the teachers during the service hour, play and take care
the disable children at the lunch time.
I certify that the information on this form is, to the best of my knowledge, truthfully reported and
in keeping with the high level of integrity of my organization.
Supervisors signature _________________________ Date _____________________________

TO BE COMPLETED BY THE STUDENT:

Student Name ___Eric Zeng ___

Students Grade level (Mandatory) G9

Student Number : _________________________

School Name __Skyline High School In Washington State , USA
Total Hours of Actual Service Given :______15 _______
Date(s) and Actual Times Worked _______5
Name of Organization

Nature of Work (actual work performed) :

I certify that the information on this form is, to the best of my knowledge, truthfully reported and
in keeping with the high standards of integrity of Skyline High School.
Students signature ____________________________ Date ________________

TO BE COMPLETED BY THE ADULT SUPERVISOR/PROJECT CONTACT:

Adult Supervisors Name ______________Xuan Haoyu__________________________
Position with agency/organization : ________ Manager__________________________
Actual # of hours the Student worked :_____15 ____
Verify with initials ____XH_________
Evaluation of the students work or comments:
___
________________________________________________________________________
I certify that the information on this form is, to the best of my knowledge, truthfully reported and
in keeping with the high level of integrity of my organization.
Supervisors signature : ________________Date ______________________