Community Service Verification Form

July 21, 2011

A Community Service Verification Form is used to verify community related activities of a candidate undertaken on voluntary basis. These activities are done towards social obligation and for the benefit of the society.

Sample Community Service Verification Form

First Name_________________Middle____________________Last Name

Date of Birth_______________________ (DD/MM/YY)

Permanent Address Street_____________________________



Day Phone_________________Mobile_________________

Email_______________________Fax Number_____________________

Community Work Details:

Name of the Organization affiliated to_____________________________

Community Service Activity    Date

From – To
Number of Hours    Verified By
Old Home
Juvenile Crimes

Description of each activity in 100 words Max.

Old Home:________________________________________________


Juvenile Crimes:______________________________________________________


Purpose/mission behind the activity

How did the Community benefit?


Write about your Experience and Impressions______________________________
Would you be interested in any other below mentioned services in future? Tick against the ones you prefer. You will be contacted soon.

1. Assisting  Community through church related Services      – Yes/No
2. Helping at the Hospital         Yes/No
3. Tutoring after school   Yes/No

Kindly sign and submit at the community office


Signature                                           Date


Download Community Service Verification Form in Word Format

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