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_____________________________

State___________________County_______________ZIP

Country_______________

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
Environment
Juvenile Crimes
Education

Description of each activity in 100 words Max.

Old Home:________________________________________________

Environment:______________________________________

Juvenile Crimes:______________________________________________________

Education:____________________________________________

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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