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1. Your Full NAME
2. Contact Information (i.e. phone number, email
address)
3. Month you are submitting the volunteer time
for.
4. Total number of hours spent in volunteer service
for this month.
5. Mileage accrued during that month.
6.
A brief description of the services you performed, e.g.,
respite
care, yard work, grocery shopping, minor repairs.
7. Any information or concerns you wish to share.
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