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* 1. Name

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* 2. Student ID#

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* 3. Volunteer Activity (Include name of organization/agency)

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* 4. Name of Volunteer Supervisor (must be a staff member or agency representative)

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* 5. Organization Phone Number

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* 6. Start Date/Time

Date
Time

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* 7. End Date/Time

Date
Time

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* 8. Total Hours Volunteered

T