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Get CSU Community Service 101 Completion Verification Form 2012-2024

Community Service 101 Completion Verification Form Student Data The following steps must be completed to receive credit for First complete the required hours of service. Student Name Date Address Phone City Zip Major Student ID No. Class Standing Frsh Soph Jr Sr Grad Agency Data Agency Name Supervisor s Name Title Agency Completion Verification This confirms that has performed hours of Name of Student This form should until all hours indicated have been finished. The hours were performed on/from. Please comment on duties and performance below. Signature of Agency Representative Jan and Bud Richter Center for Community Engagement and Service-Learning California State University Fresno 5241 N. Maple Ave. Second fill out the first two sections of this form* Third have the agency supervisor fill out and sign the bottom section of Fourth return this form during one of the Reflection Workshops at the end of the semester or to the Richter Center office by the course deadline. Student Name Date Address Phone City Zip Major Student ID No* Class Standing Frsh Soph Jr Sr Grad Agency Data Agency Name Supervisor s Name Title Agency Completion Verification This confirms that has performed hours of Name of Student This form should until all hours indicated have been finished. The hours were performed on/from. Please comment on duties and performance below. Signature of Agency Representative Jan and Bud Richter Center for Community Engagement and Service-Learning California State University Fresno 5241 N* Maple Ave. M/S TA 120 Fresno CA 93740-8027 Phone 559 278-7079 Fax 559 278-7634 Email chrisf csufresno. edu CESL Website www. Second fill out the first two sections of this form* Third have the agency supervisor fill out and sign the bottom section of Fourth return this form during one of the Reflection Workshops at the end of the semester or to the Richter Center office by the course deadline. Student Name Date Address Phone City Zip Major Student ID No* Class Standing Frsh Soph Jr Sr Grad Agency Data Agency Name Supervisor s Name Title Agency Completion Verification This confirms that has performed hours of Name of Student This form should until all hours indicated have been finished. The hours were performed on/from. Please comment on duties and performance below. Signature of Agency Representative Jan and Bud Richter Center for Community Engagement and Service-Learning California State University Fresno 5241 N* Maple Ave. M/S TA 120 Fresno CA 93740-8027 Phone 559 278-7079 Fax 559 278-7634 Email chrisf csufresno. edu CESL Website www. .

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