2. KCHB SERVICE HOURS REQUEST FORM INSTRUCTIONS

   THE SERVICE HOURS REQUEST FORM IS NOT YOUR PROOF OF SERVICE. KCHB will review the service hours request and will send you a certificate of hours served. Photo proof of participation with correct meta data is required. KCHB has the right to use any submitted materials for future awards, grants, and promotions.

4. VOLUNTEER NAME*
5. REASON FOR SERVICE HOURS*
7. PARENT/GUARDIAN NAME
   ONLY required if volunteer is a minor
9. EMAIL*
   Parent/guardian email if volunteer is a minor
10. PHONE NUMBER*
    Parent/guardian phone number if volunteer is a minor
12. CERTIFICATE IN-PERSON PICKUP OR MAIL TO ADDRESS*

    1. In-person pickup at the Government Center (285 Uptown Blvd. 2nd Floor, Cedar Hill, TX 75104)
    2. Mail to address listed below
14. MAILING ADDRESS
    ONLY required if you wish you have your certificate mailed
18. DATE OF SERVICE*
    DATE OF SERVICE
19. HOURS REQUESTED*

    Cleanups typically 1 to 2 hours.

21. BRIEF DESCRIPTION OF SERVICE*
    Include the location for cleanups
22. TRASH BAGS FILLED
    ONLY required for cleanups
24. PROOF OF SERVICE*
    Attach photo (only 1 required per service)
25. PROOF OF SERVICE
    Attach photo (only 1 required per service)
26. PROOF OF SERVICE
    Attach photo (only 1 required per service)
30. DATE OF SERVICE
    DATE OF SERVICE
31. HOURS REQUESTED

    Cleanups typically 1 to 2 hours.

33. BRIEF DESCRIPTION OF SERVICE
    Include the location for cleanups
34. TRASH BAGS FILLED
    ONLY required for cleanups
36. PROOF OF SERVICE
    Attach photo (only 1 required per service)
37. PROOF OF SERVICE
    Attach photo (only 1 required per service)
38. PROOF OF SERVICE
    Attach photo (only 1 required per service)
42. DATE OF SERVICE
    DATE OF SERVICE
43. HOURS REQUESTED

    Cleanups typically 1 to 2 hours.

45. BRIEF DESCRIPTION OF SERVICE
    Include the location for cleanups
46. TRASH BAGS FILLED
    ONLY required for cleanups
48. PROOF OF SERVICE
    Attach photo (only 1 required per service)
49. PROOF OF SERVICE
    Attach photo (only 1 required per service)
50. PROOF OF SERVICE
    Attach photo (only 1 required per service)
54. TRUTH AND ACCURACY OF FORM*

    1. ADULT VOLUNTEERS: I attest that the information in this form is true and accurate.
    2. MINOR VOLUNTEERS: I, the parent/guardian of the volunteer, attest that the information in this form is true and accurate.
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56. Submit

* indicates a required field