CSM Center for Student Life Service Hours Verification Form
This form must be used to verify the service hours provided by members of College of San Mateo clubs and/or student organizations. All service
hour projects are subject to the approval of the Student Life & Leadership Manager (and/or his or her designee). No service shall be considered
finalized unless this form is completed, submitted to the Center for Student Life, and approved by the Student Life & Leadership Manager (and/or
his or her designee).
Student Name G# Club/Student
Organization Service Project
Title Service
Organization Service
Org. Contact Phone Email Address Date(s) of Service Hours Signature of Org
Contact Date Student Life &
Leadership Manager Date Revised November 2014