Community Service Verification Form

Information you will need

• What’s the participant's name?
• What’s the participant's mailing address?
• What’s the participant's phone number?
• What’s the participant's email?
• What’s the organization’s name?
• What’s the organization’s address?
• On what date did the participant begin community service?
• On what date did the participant stop community service?
• How many hours were completed?
• Where were services provided?
• What services were provided?
• What’s the supervisor’s name?
• What’s the supervisor’s title?
• What’s the supervisor’s phone number?
• What’s the supervisor’s email?
• What’s the organization’s tax ID?

The form includes 1 signature line.