2023-2024 LI Student Leader Service Hours Verification Request Form

2023-2024 Student Leader Service Hours Verification Request Form
Name*

First NameLast Name
Student Email*
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.
Summer Internship Programs (35 hours awarded for you service at the Summer Internship Program)The International Internship Program (72 hours awarded for completing the program)Leadership Initiatives Internship (varies depending on commitment)
International Leadership & Business InternshipAdvanced Law & Trial Internship Tier IAdvanced Law & Trial Internship Tier IIAdvanced Medical & Public Health InternshipAdvanced Medical Neuroscience InternshipNational Security & Intelligence InternshipCybersecurity & Defense InternshipMiddle School Jumpstart Program
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
YesNo
Title*
i.e. Guidance Counselor
Name of contact

First NameLast Name
Email Address*
Phone number*
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.*

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

2023-2024 Student Leader Service Hours Verification Request Form