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Application - Palos Verdes High School

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Service Description Sheet<br />

List service activities and hours with the signature of an adult who can verify your participation. Print the<br />

name before getting the signature. No student signatures will be accepted. Provide phone numbers for people<br />

off this campus.<br />

Service Year<br />

(check box)<br />

9 10 11 12<br />

Organization Description of Activity # of<br />

Hours<br />

Worked<br />

Name of Adult<br />

Supervisor<br />

Signature/<br />

Phone Number

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