Southwest Miami High School Community Service Activity Log Form
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2SOUTHWEST MIAMI HIGH SCHOOL
COMMUNITY SERVICE ACTIVITY LOG FORM
Last Name: _______________ First Name: ____________________
Middle____________________
ID Number: _______________ Class of: ______________________
Grade: ___________________
Supervisor’s
Date
Description of Service
Time
Time
Total
Contact Name and
Signature
Number
Mm/dd/yy
Performed and Location
In
Out
Hours
I have reviewed and understand that 20 hours of community service will be completed in order to meet
graduation requirements for Miami-Dade Public Schools.
Total Number of Hours: _________
________________________
_________
_____________________________
_____________
Student’s Signature
Date
Social Studies Teacher Signature
Date
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