OE NHS INDUCTEE Service Hour Form
Please record all service hours honestly; officers will check hours for verification.
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Last Name *
First Name *
Description of service activity *
Date of service (month/day/year) *
MM
/
DD
/
YYYY
Number of Hours (round to nearest half-hour) *
Organization/Group/Person that received service *
Organization/Group/Person Contact Information (Phone Number or Email) *
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