COMMUNITY SERVICE FORM
Student Name Student ID
E-mail
Phone
College
Term/Semester/Year (ex. Fall 2019)
Organization
Organization Contact
Organization Contact Email
Organization Phone
Organization Address
Activity/Event Description and what was your role:
I verify that I completed ______ hours of unpaid community service above and meets the institution’s
guidelines for community service.
Student Signature
Organization Contact Signature
College Representative Signature Approved by College (Date)
Students in the West Virginia Invests Grant program must complete two hours of community service each
term in which funds are received as approved by the institution. Community service hours completed before
or after the term do not count toward the two hour requirement. Failure to complete and document the
completion of the community service requirement will result in the student becoming ineligible for the West
Virginia Invests Grant. Go to www.wvinvests.org for more information.
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signature
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signature
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signature
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