LEBANON CATHOLIC SCHOOL SERVICE COMMITMENT INFORMATION

Last Name ____________________ First Name_____________

Program______________________ Total Hours__________

Description _______________________________________________

__________________________________________________________

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Contact Name (please print)__________________________________

Organization______________________________________________

Full Address______________________________________________

Phone number___________________ E-Mail address____________

The student named above has successfully completed the stated hours of volunteer service under my supervision.

(signature)_____________________________________ (date)_______________________________