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100 Hours Form for Organisations

Organisation Name:

Confirmation of information

I confirm that the following volunteers have started volunteering since 1st April 2007 and completed 100 hours of volunteering within a 12-month period (PLEASE PRINT NAMES) (The information required is the date each volunteer started volunteering, their ethnicity and whether or not they have a disability. Please record all this information) Please complete this form on-line or post/email our printed versions to Volunteer Centre Merton, The Vestry Hall, London Road, Mitcham CR4 3UD; email: info@volunteercentremerton.org.uk

Name:

Start date:

Ethnicity:

Disability/mental health issue/long term illness:

Yes

No

Name:

Start date:

Ethnicity:

Disability/mental health issue/long term illness:

Yes

No

Name:

Start date:

Ethnicity:

Disability/mental health issue/long term illness:

Yes

No

Name:

Start date:

Ethnicity:

Disability/mental health issue/long term illness:

Yes

No

Name:

Start date:

Ethnicity:

Disability/mental health issue/long term illness:

Yes

No

Name:

Start date:

Ethnicity:

Disability/mental health issue/long term illness:

Yes

No

Name:

Start date:

Ethnicity:

Disability/mental health issue/long term illness:

Yes

No

Name:

Start date:

Ethnicity:

Disability/mental health issue/long term illness:

Yes

No

Signature

Please print your name and date your submission on behalf of your organisation.

Signed:

Date:

Address: The Vestry Hall, London Road, Mitcham, Surrey CR4 3UD

Telephone: 020 8640 7355 | Fax: 020 8646 7549 | Email: info@volunteercentremerton.org.uk

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