SERVICE VERIFICATION FORM

THE VERNETTA WILSON MEMORIAL SCHOLARSHIP
SERVICE VERIFICATION FORM
Thank you for helping this student apply for the Vernetta Wilson Memorial Scholarship, which provides two-year or four-year college scholarships to African-American and students of African descent who are high school seniors in Minnesota who display academic achievement, leadership qualities, and a commitment to serving others.

Persons within the organization(s) for which the student has performed service or persons within a coordinating service organization/group/club (AVID Program Coordinator, National Honor Society Advisor, School Outreach/Community Service Coordinator, etc.) may complete this form. Alternatively, a separate letter of recommendation may be provided to the student if it contains the information below.

Please complete this form and provide the output PDF file you receive to the student. Alternatively, you may provide a separate reference letter to the student (.pdf, .doc or .docx format), provided that it includes the requested information below.
Student’s Name:*
Type a question
Your Name:*
Your Organization:*
Your Title:*
E-mail Address:*
example@example.com
Phone Number*
Please enter a valid phone number.
Please comment on the following topics regarding this student:
Number of Service Hours*
Applicants are encouraged to submit all service hours performed.
Academic or calendar year(s) in which service hours were performed:*
Please address the student’s community service participation. In what capacity did the student perform community service? What impact did the student have on the organization(s) for which he/she performed community service?*

10 to 150 words0/150
Upload Recommendation Letter

Upload a separate letter describing the student's service (optional). PDF, doc, docx, txt, rtf files accepted.
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Electronic Signature*

By checking here, I attest to the accuracy of the information provided.
Signature
Date*

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Please preview the PDF to check for any text formatting issues before submitting. Thank you for your assistance.
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THE VERNETTA WILSON MEMORIAL SCHOLARSHIP

SERVICE VERIFICATION FORM