2022-2023 LI Student Leader Service Hours Verification Request Form

LI Student Leader Service Hours Verification Request Form
The 2022-2023 Session has now concluded. To request new service hours, please use the form here
Student First Name*
Student Last Name*
Student Email*
example@example.com
Student Phone Number*
Below are the number of hours that students may receive from Leadership Initiatives' various programs.

Online Youth Development Program students are eligible to receive a total of 50 hours of community service for their participation. This number will be reduced if a student did not attend every day of the summer internship.

International Internship Program students are eligible to receive 2 hours of community service for each week they participated in the program. This only applies to weeks where students successfully held facilitator and/or project coordinator calls. Missed weeks and time off may not be counted towards a student's service hours.
Are You Requesting Service Hours For...

Summer Youth Development ProgramsThe International Internship ProgramLeadership Initiatives Internship
Summer Youth Development Program Attended*

The International Leadership & Business InternshipAdvanced Law & Trial Internship Tier IAdvanced Law & Trial Internship Summit Tier IIAdvanced Medical & Public Health InternshipAdvanced Medical Neuroscience InternshipNational Security & Intelligence Internship
IIP Team Number*
Will be listed in IBIP Google Sheet
IIP Facilitator First Name*
Will be the staff member signing your hours
How Many Service Hours Are You Requesting?*
Start Date of Service Hours*

MonthDayYear
Date
End Date of Service Hours*

MonthDayYear
Date
Would you like us to contact a school official for verification purposes?*

YesNo
Title*
i.e. Guidance Counselor
First Name*
Last Name*
Email Address*
Phone Number
Do you require us to fill out a Service hour verification form or write a letter to confirm your service hours?*

Fill out a formWrite a letterOther
Service Hour Verification Form - Please Make Sure You've Filled Out All Necessary Fields Before Form Is Submitted. DO NOT Submit a blank form.*

Browse Files

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Please Explain What You Would Like Included In The Letter*
Should be Empty: