Voluntary

Service Certificate of Excellence

Application Form
Please print this form as it needs to be signed by the person-in-charge at your
volunteering organization (External/Internal). We will contact the organization once
we have received the form to check the details.





Date of Submission: ______________________

Personal Details
Student Name (Name as in IC): _________________________
Student ID/Batch: ___________________________________________
Student Email: ______________________________________
Contact Number: ____________________________________

Volunteering Details
Name of Club/ Organization: ____________________________________________
Address of Organization: ________________________________________________

________________________________________________

Start date for this volunteering activity (dd/mm/yyyy): _______________________
End date for this volunteering activity (dd/mm/yyyy): _______________________
Total number of hours that you volunteered: _______________________________
Position held (if any): ___________________________
No. of training hours (if any): ______________________
Activity Description:
_____________________________________________________________________
_____________________________________________________________________

Presidents of IMU Clubs, Lecturers, Event Chairperson and External

Supervisors are to adhere to the following regulations before verification of
applicants information activity:

i. To ensure applicants are current students from IMU and all given personal information are
true.

ii. To verify with the organizing chairperson of the event regarding the number of hours, all
relevant information about the activity and the performance of the applicant throughout the
community activity.

[The organizing chairperson is the person responsible for supervising volunteers and
overseeing the entire activity, of whom may include you]

iii. Your signature of approval on the form indicates that you have completed the above and
therefore approve the applicants activity under your name or club/organizations name.

iv. You shall be held liable should there be any discrepancies or falsification of information.
Any proof of falsification of data may result in one being barred from applying his certificate
or that your signature of approval or club activities will not be recognized by the approval
committee for the one year period.

Name of Organizations Representative (Name as in IC):

_____________________________________________________

(Event Chairman/ Club President/ Lecturer-in-charge/ External Supervisors ONLY)

Representatives contact no: __________________________________________

Representatives Email address: __________________________________________

Representatives Signature: ______________________________


Forms must be printed and sent to:
Social Concerns Representative,
Student Representative Council (SRC) Office
If you have any queries, please email: imuvsce@student.imu.edu.my

For Office Use

Date received:
Approval Stamp: