Gender: High School: Expected Graduation Year: Mailing Address: City: Zip: Home Phone: Cell: Email: ***Seniors qualify to for the Labor and School Community Service Scholarship. Please contact United Way office for instructions.*** I have previously received my Varsity Letter in Community Service I have previously received my Varsity Letter for a different activity I have never received my High School’s Varsity Letter for any activities I attest that I performed the documented hours of community service included in the attached verification forms and met all the qualifications as outlined by United Way of Washtenaw County on the web site. To my knowledge, these hours are valid and count toward my earning the Letter in Community Service. Student Signature: Date: Parent/Guardian Please read the passage below and sign giving your child permission to participate in this award program. I hereby assign to United Way of Washtenaw County all rights to video and audio recordings and all photographs of my child made in connection with Letter in Community Service activities. I hereby authorize editing, duplication, reproduction, copyright, exhibition, broadcast and/or other use and distribution of such recordings or quotations for purposes deemed suitable by United Way of Washtenaw County. I also waive any right to approve or disapprove the finished products. Parent/Guardian Name: Parent Guardian Signature: Date: We would like the opportunity to keep you informed of our programs, and would like to add you to our mailing list (which is not shared with others). If you prefer not to be added please check the box below. Please do not add me to the mailing list Varsity Letter in Community Service Community Service Verification Form Deadline for application May 15, 2018 A copy of this form must be completed for each agency/organization/school/club for which you have performed service, so duplicate this page as necessary. (i.e. only one form is needed with the total # hours spent with Key Club). Remember to apply enough postage when mailing your application; standard postage is often not adequate.
Gender: High School: Expected Graduation Year: Mailing Address: City: Zip: Home Phone: Cell: Email: ***Seniors qualify to for the Labor and School Community Service Scholarship. Please contact United Way office for instructions.*** I have previously received my Varsity Letter in Community Service I have previously received my Varsity Letter for a different activity I have never received my High School’s Varsity Letter for any activities I attest that I performed the documented hours of community service included in the attached verification forms and met all the qualifications as outlined by United Way of Washtenaw County on the web site. To my knowledge, these hours are valid and count toward my earning the Letter in Community Service. Student Signature: Date: Parent/Guardian Please read the passage below and sign giving your child permission to participate in this award program. I hereby assign to United Way of Washtenaw County all rights to video and audio recordings and all photographs of my child made in connection with Letter in Community Service activities. I hereby authorize editing, duplication, reproduction, copyright, exhibition, broadcast and/or other use and distribution of such recordings or quotations for purposes deemed suitable by United Way of Washtenaw County. I also waive any right to approve or disapprove the finished products. Parent/Guardian Name: Parent Guardian Signature: Date: We would like the opportunity to keep you informed of our programs, and would like to add you to our mailing list (which is not shared with others). If you prefer not to be added please check the box below. Please do not add me to the mailing list Varsity Letter in Community Service Community Service Verification Form Deadline for application May 15, 2018 A copy of this form must be completed for each agency/organization/school/club for which you have performed service, so duplicate this page as necessary. (i.e. only one form is needed with the total # hours spent with Key Club). Remember to apply enough postage when mailing your application; standard postage is often not adequate.
2017-18%20Varsity%20Letter%20Application.docx