PRESIDENT’S VOLUNTEER SERVICE AWARD – Student Tracking Form

 

Directions:  Copy this page and paste into Word.  Complete, sign, and return to the Gifted & Talented Office

by March 1 of each year; awards will be presented at the end of the school year during both the underclass

and senior awards ceremonies.                                                  Circle Grade:    9   10   11   12

  

First Name:   MI Last Name:
Street Address:  City/ZIP:

Phone: 

Age              DOB: Gender:
E-mail: 

                                                                                                                             

Tracking Volunteer Hours (to add additional rows, click in the last cell and return)--

       Medals (age 15 - 25):  Bronze, 100-174 hours; Silver, 175-249 hours; Gold, 250+  (Note:  For up to age 14, 50-hour minimum)

 

Dates

Activity/Description/Place

Type (see key)

No. Hours

 Contact Phone
Number - Area Code if not 908

 

 

 

 

  

 

 

 

 

  

 

 

 

 

  

 

 

 

 

  

 

 

 

 

  

 

 

 

 

  

 

 

 

 

  

 

 

 

 

  

 

 

 

 

  

 

 

 

 

  

 

 

 

 

  

 

 

 

 

  

Total No. of Hours March 1, 2007, to March 1, 2008

 

  

 

Types of activities/check where applicable:
 

    q Youth Achievement (YA)                               q Healthy Communities (HC)
 

    q Parks and Open Spaces (POS)                     q Public Safety and Emergency Response (PSE)

 

CERTIFICATION STATEMENT:  I certify the above information is accurate.

 

 

Student Signature:____________________________________   Date:  ________20___