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M. Marion Ranney Chapter of the
National Honor Society
Independent
Service Project Hours Verification Form
Member Name: ______________________________________
Service
Project Description: __________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Hours
Performed:
____________________________________________________________
Date(s)
Performed:
____________________________________________________________
Adult
Contact Name:
____________________________________________________________
Contact
Phone Number:
____________________________________________________________
Contact
email if available:
____________________________________________________________
Contact Signature:
By signing this form you attest to
the fact that the above named Honor Society member satisfactorily performed
the service described herein and did it without any benefit to his/herself.
Signature:
_________________________________________________
Date:
___/____/______
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