Verification Form - VLCS 2022 to 2023

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A copy of this form must be completed for EACH agency (nonprofit organization, school, or club) for which you have performed service (i.e. Only one form with the total # of hours spent with Key Club is needed).

*This form is the SAME as the Verification Form found on page 4 of the printable VLCS application. Either paper or electronic forms will be accepted, but please be consistent.*

VLCS Application Dates: March 1, 2022 - February 28, 2023

Application Deadline:

Student Name (First and Last) *

Email address *

Name of volunteer agency (nonprofit organization, school, or club) in which you volunteered *

Total # of volunteer hours with this agency *

Name and title of Volunteer Supervisor. *

I was an: *

Ongoing volunteer

One-time volunteer

When did you volunteer? (Date(s) must fall between 10/1/2021 & 9/30/2022) *

This volunteer opportunity is: *

School related

Non-school related (outside of school activities)

This volunteer opportunity supports: *

Education

Health

Financial Stability

Other:

Briefly describe the community service you performed. *

What have you learned about YOURSELF through this volunteer experience? *

What have you learned about our COMMUNITY through this volunteer experience? *

I have/I will verify my volunteer experience by completing ONE of the following options. *

Submit a photo of this volunteer experience.

Submit a piece of agency letterhead signed by the volunteer supervisor.

Submit

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