OF ACTIVITY COMPLETED (e.g., picture of completed mask, screen shot of social media project, emails, other pictures, copy of letter written to a nursing home resident including name of the home, other evidence as appropriate/applicable):

1. STUDENT NAME: 2. ACTIVITY COMPLETED: 3. PASTE PICTURE/PHOTOGRAPH OF ACTIVITY COMPLETED (e.g., picture of completed mask, screen shot of social media project, emails, other pictures, copy of letter written to a nursing home resident including name of the home, other evidence as appropriate/applicable): 4. TOTAL NUMBER OF HOURS YOU INVESTED IN THE ACTIVITY: (Minimum required is 5 hours) 5. ANY OTHER COMMENTS YOU WISH TO MAKE ABOUT YOUR ACTIVITY: 6. DATE WHEN YOU COMPLETED THE ACTIVITY:

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OF ACTIVITY COMPLETED (e.g., picture of completed mask, screen shot of social media project, emails, other pictures, copy of letter written to a nursing home resident including name of the home, other evidence as appropriate/applicable):

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