Personal Data Verification Form - Lisgar Collegiate Institute

LISGAR COLLEGIATE INSTITUTEPersonal Data Verification FormFORMAStudent’s Name:Date:Please complete this form and return it to the student services office.In-School ActivitiesTeachers : Please verify by signing below, the information provided by this student regarding theirinvolvement in a club or activity you supervised is accurate.ActivityTotal Number of Hours of your InvolvementPrint Teacher’s NameTeacher’s signatureActivityTotal Number of Hours of your InvolvementPrint Teacher’s NameTeacher’s signatureActivityTotal Number of Hours of your InvolvementPrint Teacher’s NameTeacher’s signatureActivityTotal Number of Hours of your InvolvementPrint Teacher’s NameTeacher’s signatureActivityTotal Number of Hours of your InvolvementPrint Teacher’s NameTeacher’s signature10/4/2010

LISGAR COLLEGIATE INSTITUTEPersonal Data Verification FormFORMAExternal ActivitiesPlease provide detailed information of your involvement in activities outside the school (ie: musiclessons, part-time work, community involvement activities, etc.) including contact information of yoursupervisors (ie: name, phone numbers and email addresses).*Parents/Guardians may verify this information by signing in place of the supervisor.ActivityTotal Number of Hours of your InvolvementSupervisor’s Phone NumberEmail AddressName of SupervisorSupervisor’s signatureActivityTotal Number of Hours of your InvolvementSupervisor’s Phone NumberEmail AddressName of SupervisorSupervisor’s signatureActivityTotal Number of Hours of your InvolvementSupervisor’s Phone NumberEmail AddressName of SupervisorSupervisor’s signatureActivityTotal Number of Hours of your InvolvementSupervisor’s Phone NumberEmail AddressName of SupervisorSupervisor’s signature10/4/2010