Verified Hours Application

Are you in need of verified community service hours? HOPE Clinic does their best to work with court ordered, school ordered, or group ordered people. Please tell us how many hours you need and what you can do. HOPE Clinic will do their best to fit your needs, however we can not promise you a placement. It does take HOPE about a month to place you and get you started. Please apply if you think we can help. 

Please write our exactly what it is you will need in order to fulfill these hours. When do you need your hours completed by? What documentation will you need from us?
Please include any contact information you might have for whom these hours are for in case we need to follow up with them.
What days and times are you available to come and volunteer?
Are there any particular skills or interests that you have? Let us know about them. The more we know about who you are the better we will be able to determine if we have a place for you.
Name *
Name
Date of Birth *
Date of Birth
Street Address, City, St, Zip
Phone *
Phone
We don't require you to be a member of a church to work with us, but if you are involved in a church we would love to know about it.
Would you like to be added to our mailing list? *
Billy Kangas