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Service form requirement for Tennessee Weslyan Students
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The Center for Service & Leadership reserves the right to verify any information presented on this form.
PLEASE RETURN THIS FORM TO: Service & Leadership at TWC, 204 E. College St., Athens, TN 37303 Phone: (423) 746-5231 Fax: (423) 744-9968
Tennessee Wesleyan College SERVICE VERIFICATION FORM
This form must be submitted within 90 days of participation to track your service activities.
TO BE FILLED OUT BY STUDENT:
Name: _____________________________________
Major: _____________________________________
Phone #: ______________
E-mail Address: [email protected]
Project Date(s): ___ /___ /______ − ___ /___ /______
Name of Organization Served: _______________________________________________________
Project Summary: _______________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
TO BE FILLED OUT BY SERVICE PROJECT SUPERVISOR
Name (Please Print): ________________________________ Phone #: ___________________
Email Address: ________________________________________________________________
Address: ____________________________________________________________________
TOTAL Number of Hours Student Served: _________
Supervisor Signature (upon completion): _________________________________________
OFFICE USE
Received: ___/___/___ By: __________
Approved: ___/___/____ By: ___________ Hours Earned: _____
Are you graduating this semester?
□Yes □No
Student ID #: _______________________________
□Yes □No
Was this service completed with a Classification: Freshman Sophomore Junior Senior Service-Learning course?
