Parkview Baptist School High School Community Service Form printable pdf download

HIGH SCHOOL

COMMUNITY SERVICE FORM

Grade Level: _____9 _____10 _____11 _____12

Graduation Year: __________________ Today’s Date: _____________________

Student Name: _______________________________________________________________________________________________________________

COMMUNITY SERVICE ACTIVITY INFORMATION

(Please Print)

ORGANIZATION/SPONSOR: ___________________________________________________________________________________________________

DATE OF PROJECT: _________________________________________

DESCRIPTION OF COMMUNITY SERVICE ACTIVITY: _______________________________________________________________________

___________________________________________________________________________________________________________________________________

TOTAL NUMBER OF PROJECT HOURS COMPLETED: __________________

ORGANIZATION SUPERVISOR’S AGREEMENT: I verify that the above student has successfully completed the

community service project as stated above and has acquired ______ number of hours.

___________________________________________________________________________________________________________________________________

Supervisor’s Name (Printed) and Signature

________________________________________

_________________________________________________________________________________

Supervisor’s Phone Number (Contact Number)

Supervisor’s e-mail address

PARENT AGREEMENT: I certify that my son/daughter has completed the community service project as outlined

above. _________________________________________________________________________________________________________________________

Parent’s/Legal Guardian’s Name (Printed) and Signature

STUDENT AGREEMENT: I have successfully completed this community service project as stated above. I have

acquired the number of hours indicated and I understand that these hours for community service are being

considered as part of my graduation requirement from Parkview Baptist High School.

___________________________________________________________________________________________________________________________________

Student’s Name (Printed) and Signature

For office use only:

# _______________________

Date form received: _______________

Date hours recorded: ________________

Initials: __________________

Parkview Baptist School High School Community Service Form