Concord-Carlisle Community Chest

VOLUNTEER SERVICE AWARD

FOR OUTSTANDING SERVICE IN THE FIELD OF HUMAN SERVICES

Nominee ______________________________________________________________________

Address ______________________________________________________________________

Phone ____________________________

School _______________________________________________________ Year ___________

Project Details__________________________________________________________________

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Services Provided_______________________________________________________________

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How Project Evolved ____________________________________________________________

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Person Who Can Verify Project: (include telephone #)

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Will nominee be continuing on this project? If so, until when? ____________

If not, is the project continuing? ____By whom? ______________________________________

Was nominee involved in transfer and "training" of new volunteer? _______

I understand that I/nominee must be a high school student of good standing.

Signed ______________________________________________________________________

Address _____________________________________________________________________

Phone __________________________________