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.

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Volunteer Service
Start date & end date (if applicable) of service:
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Days of week & hours worked: (e.g. Mondays & Wednesdays, from 9 AM - noon)
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Total hours served to date:
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Please describe the duties and work performed.
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Any comments you'd like to share about the applicant's service?