VALENCIA COMMUNITY COLLEGE R&R EDS AGENCY COMMUNITY SERVICE FORM (TO BE MAILED BY AGENCY) DATE: ________________________
NAME: ________________________________________________ PHONE#: (_____)___________________ (Organization) ADDRESS ________________________________________________________________________________ (Street) (City/State) (Zip) VOLUNTEER NAME: ________________________________________ TOTAL HOURS: _______________ SUPERVISOR: ______________________________ DATE: (Start)______________ (End)_______________
(Please complete the evaluation below by checking the appropriate boxes) AREAS
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AVEREAGE
FAIR
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SUPPORT & SERVICE PROVIDED BY THIS OFFICE
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VOLUNTEER’S ATTENDANCE & TIMELESSNESS VOLUNTEER’S OVER-ALL RESPONSIBLENESS VOLUNTEER’S OVER-ALL PERFROMANCE
COMMENTS:_______________________________________________________________________________________________
OFFICIAL USE ONLY: DATE:_____________
CREDIT ASSIGNED:___________________ APPROVED:____________________________________
COMMENTS:________________________________________________________________________________________________