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Volunteer Record Form

 
Name / Org. Name:
Phone:
Email:
P.O. Box:
This service was for:
I am a (mark all that apply):

SERVICE HOURS

Agency or Project Name:
Agency Contact Person:
Contact Email:
Contact Phone:
Project Start Date:
Project End Date:
Project description:
Total Number of hours volunteered:
 

DONATIONS

Receiving Agency:
Amount of money:
Number of food items:
Number of clothing items:
Other (please describe):

ORGANIZATIONS ONLY

Name of Organization:
 
Number of people who volunteered:
 
Number of hours per person:
 
Total number of hours volunteered:
 
VERIFICATION BELOW REQUIRED: I hereby attest, by entering my name below and submitting this form, that all the information listed on this form is true and correct.
 
Verification Signature