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INDIANA HOMELAND SECURITY FOUNDATION - page 2 / 3

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Sample Volunteer/Activity Record

(Attach additional pages if necessary. Designate hours when applicable. You may include high school activities.)

Name and Location of Activity: ___________________________________________________

Dates of Activity: ___________________________Position: ___________________

Responsibilities: _______________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Name and Location of Activity: __________________________________________________

Dates of Activity: ___________________________Position: ___________________

Responsibilities: _______________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Name and Location of Activity: ___________________________________________________

Dates of Activity: ___________________________Position: ___________________

Responsibilities: _______________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

List Awards/Honors and Date Received: ___________________________________________

______________________________________________________________________________

______________________________________________________________________________

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