SimpleForms :: Service Hours Submission

Service Hours Submission

The information entered into this form is kept in a secure database and can be verified by the Center for Civic Engagement when needed.

STOP: If your service hours are required for a course, do not use this form.

Exercise Physiology Students: You must have had your first appointment and received prior approval before using this form.

Name:

required

Student ID:

required

Address:

City:

State:

Zip Code:

Example: 12520

Phone:

Example: (555) 555-5555

Email Address:

Example: dmolsen@hotmail.com

Volunteer Program

required

Service Activity:

required

Agency or Organization:

required

Contact Name:

required

Contact Phone

required

Example: (555) 555-5555

Date of Service:

required

Example: MM/DD/YYYY

Description of Service:

required

Total Hours:

required

Signature:
Please type your full name in agreement that all information is truthful and accurate.
required

WVU's SimpleForms

Service Hours Submission