Event Verification Form

To verify service, please complete this form for each different event and submit with your portfolio.

Nameof Event: Kl te, fc|\

Organization: Ttlt*rt APf5
TypeofService, Q.:Sf rrag..rr+t..h/rr+rrp . ,^.r.r.I {3o9,} q hsv. CpOrdlrrrr"uton

Describe your service activities:

Date of $erv ice: L*!3g13 start time: ho,-. End time: 5 f,rr.
TotalHours: l

Supervisor lnformation

Name:

Position:

Phone:
OR
Email:

Signature:

Student lnformation

K""\" -Tqvy,h .
Name:

signature:
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