2008-2009

  

                                                 St. Rose School

                                       Christian Service Hour Verification Form

 

Student Name:__________________________Teacher___________________________

Check One:      School ________

                        Home_________

                        Church________

Indicate the type of work performed and write a brief description: ________________________________________________________________________________________________________________________________________________________________________________________________________________________

Date(s) work was performed:   _______________      Total hours worked:      ____________

                                                _______________                                          ____________

Contact Person Signature:___________________________________________________