Applicant
 Name:___________________________________________________________________________________

 Date Of Project: ______________________________

 Total # Of Hours You Spent On This Project/Activity: _____________

 Description Of Project/Activity:

 Certification: (To be signed by Chapter President or Descendant Director and
 any other authority supervising the project or activity.)

 I have reviewed the above project/activity and certify that it is correct.

 Chapter President/Descendant Director:

_________________________________________________________________________________________
        Signature                      Title                            Phone                   Email if applicable         Date

 Supervising authority for the project/Activity:

_________________________________________________________________________________________
         Signature                                Title                                     Phone                                Date