FS HCA Volunteer Verification Page - Columbia Bible College

Volunteer/Work Service Confirmation Form

Contact Info

Thank you for being willing to provide confirmation of the volunteer hours (or work hours in a related field) for an applicant to our Health Care Assistant Certificate program. Please complete all the fields below. Note that the form will time out after 20 minutes of inactivity.

Applicant's Name*

Site of Completed Hours (e.g. Communitas)*

Your Name

Your role/title:

Phone number*

Email:

Volunteer Service

Start date & end date (if applicable) of service:

Days of week & hours worked: (e.g. Mondays & Wednesdays, from 9 AM - noon)

Total hours served to date:

Please describe the duties and work performed.

Any comments you'd like to share about the applicant's service?