VOLUNTEER RESOURCE CENTER
COMMUNITY SERVICE VERIFICATION FORM
Student: ______________________________________________________________________
Community Partner: ____________________________________________________________
Location: _______________________________________ City/County: ___________________
Project/Event: _________________________________________________________________
Type of work performed: _________________________________________________________
______________________________________________________________________________
Verification
Student Service Verification to be filled out by a site supervisor at partnering agency.
I, _______________________________, hereby acknowledge that _______________________
(site supervisor)
(student)
successfully performed ___________ hours of community service on _____________________.
(total)
(date of service)
Signature: ______________________________________________ Date: ________________
Email: __________________________________ Phone: _______________________________
Follow Up
Student Service Follow Up to be filled out by an advisor at Montclair State University.
Name and Title: _______________________________________________________________
_______________________________________________________________
Date of Verification: ____________________________________________________________
Signature: ____________________________________________________________________
Please return a copy of this completed form to the Volunteer Resource Center (Student Center, 104J).