LI Student Leader Service Hours Verification Request Form
Student First Name
*
Student Last Name
*
Student Email
*
example@example.com
Student Phone Number
*
Format: (000) 000-0000.
Are You Requesting Service Hours For...
Summer Youth Development Programs
The International Internship Program
Leadership Initiatives Internship
Summer Youth Development Program Attended
*
The International Leadership & Business Internship Summit
The International Leadership & Business Internship Summit Tier II
Advanced Law & Trial Internship Summit
Advanced Law & Trial Internship Summit Tier II
Advanced Medical & Public Health Summit
Advanced Medical Neuroscience Summit
IBIP Team Number
*
Will be listed in IBIP Google Sheet
IBIP Facilitator First Name
*
Will be the staff member signing your hours
How Many Service Hours Are You Requesting?
*
Start Date of Service Hours
*
-
Month
-
Day
Year
Date
End Date of Service Hours
*
-
Month
-
Day
Year
Date
Would you like us to contact a school official for verification purposes?
*
Yes
No
Title
*
i.e. Guidance Counselor
First Name
*
Last Name
*
Email Address
*
Phone Number
Format: (000) 000-0000.
Do you require us to fill out a Service hour verification form or write a letter to confirm your service hours?
*
Fill out a form
Write a letter
Other
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
*
Submit
Should be Empty: