Community Service Validation*
Dover Intermediate School
Student: ________________________________ HR ______ performed Community Service on ____________
Print first and last name
Date
I worked from (time) ________ to ________ for ____ hours at (place) _______________________________________.
My job was to ______________________________________________________________________________________.
The person or group I helped was ______________________________________________________________________.
Signature of an adult (not a parent or relative) verifying the service hours. ____________________________________
* Community Service does not include helping family or relatives. Work should be done helping people in your
neighborhood, church, school, community, etc.
_________________________________________________________________________________________________________
Community Service Validation*
Dover Intermediate School
Student: ________________________________ HR ______ performed Community Service on ____________
Print first and last name
Date
I worked from (time) ________ to ________ for ____ hours at (place) _______________________________________.
My job was to ______________________________________________________________________________________.
The person or group I helped was ______________________________________________________________________.
Signature of an adult (not a parent or relative) verifying the service hours. ____________________________________
* Community Service does not include helping family or relatives. Work should be done helping people in your
neighborhood, church, school, community, etc.
_____________________________________________________________________________
Community Service Validation*
Dover Intermediate School
Student: ________________________________ HR ______ performed Community Service on ____________
Print first and last name
Date
I worked from (time) ________ to ________ for _________ hours at (place) __________________________________.
My job was to ______________________________________________________________________________________.
The person or group I helped was ______________________________________________________________________.
Signature of an adult (not a parent or relative) verifying the service hours. ____________________________________
* Community Service does not include helping family or relatives. Work should be done helping people in your
neighborhood, church, school, community, etc.