Young Leaders In Service Award

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50 hours of community service = Silver Seal Award 100 hours of community service = Gold Seal Award FIRST (GIVEN) NAME LAST (FAMILY) NAME STREET ADDRESS CITY STATE/PROVINCE TELEPHONE Date(s) E-MAIL Service Activity AGE Service Category Code POSTAL CODE ❏ MALE ❏ FEMALE Place of Service Hours TOTAL HOURS SERVICE CATEGORY CODES In column above, use the following codes to indicate the category of service for each activity: 1 - Environment 2 - Public Health 3 - Safety 4 - Literacy and Education 5 - Disaster Relief 6 - Community Improvement 7 - Help Children 10 - Other 8 - Help Elderly People 9 - Help Homeless/Hungry People I certify that the above information is accurate.. (Please fill in number of hours in front of all categories in which the youth served.) 1 - Environment 4 - Literacy and Education 7 - Help Children 10 - Other 2 - Public Health 5 - Disaster Relief 8 - Help Elderly People 3 - Safety 6 - Community Improvement 9 - Help Homeless/Hungry People LIONS YOUNG LEADERS IN SERVICE AWARDS SCHOOL/YOUTH GROUP AWARD CERTIFICATION FORM (continued) For use by the school/youth group adult leader Photocopy this page as needed for additional award recipients.. (Please fill in number of hours in front of all categories in which the youth served.) 1 - Environment 4 - Literacy and Education 7 - Help Children 10 - Other 2 - Public Health 5 - Disaster Relief 8 - Help Elderly People 3 - Safety 6 - Community Improvement 9 - Help Homeless/Hungry People Youth Information FIRST (GIVEN) NAME LAST (FAMILY) NAME STREET ADDRESS CITY TELEPHONE STATE/PROVINCE E-MAIL ❏ MALE ❏ FEMALE AGE Award Level Achieved: ❏ Silver Seal Award (50 service hours in a 12-month period) ❏ Gold Seal Award (100 service hours in a 12-month period) Approximate number of hours in each service category as reported on Youth Service Tracking Form.. (Please fill in number of hours in front of all categories in which th

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