2024 - 2025 LI Student Leader Service Hours Verification Request Form

2024-2025 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.

Summer Internship Program students are eligible to receive a total of 35 hours of community service for their participation and completion of their internship.

International Internship Program students are eligible to receive 76 hours of community service for their participation. Interns who do not submit the final project will not receive service hours.
Are You Requesting Service Hours For...

Summer Internship Programs (35 hours awarded for you service at the Summer Internship Program)The International Internship Program (76 hours awarded for completing the program)Leadership Initiatives Internship (varies depending on commitment)
Summer Internship Program Attended*

International Leadership & Business InternshipCriminal Law & Trial InternshipAdvanced Law & Justice Reform InternshipAdvanced Medical & Public Health InternshipAdvanced Medical Neuroscience InternshipNational Security & Intelligence InternshipCybersecurity & Defense InternshipMiddle School Jumpstart Program
IIP Team Number*
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
Name of contact

First NameLast 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

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

2024-2025 Student Leader Service Hours Verification Request Form