Delaware Volunteer Credit Program
Completion Verification Form

Student
Grade
Home Address
Home Telephone #
Alternative #


School/Address
ID #
School Official
Telephone #
Fax #


Agency 
Hours
Site Supervisor
Date
Site Supervisor Signature
Telephone #
Fax #


Agency
Hours
Site Supervisor
Date
Site Supervisor Signature
Telephone #
Fax #

Agency
Hours
Site Supervisor
Date
Site Supervisor Signature
Telephone #
Fax #


Agency
Hours
Site Supervisor
Date
Site Supervisor Signature
Telephone #
Fax #


Agency
Hours
Site Supervisor
Date
Site Supervisor Signature
Telephone #
Fax #
    								
Student:  Submit to High School Guidance Office
High School Guidance Office: Mail by April 15    					 


 						    MAIL TO: Volunteer Resource Center
									 State Office of Volunteerism	
									1901 North DuPont Highway
									Charles Debnam Building
									New Castle, DE 19720
									1-800-815-5465
									(302) 255-4462 (FAX)