Community Service Form Page 2
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1
2Community Ser
Community Service Form
vice Form
Community Ser
Community Ser
vice Form
vice Form
S S S S tudent
tudent
tudent Information
tudent
Information
Information
Information
Student Name
Today’s Date _____________
Current Grade
*Please note: Summer service hours may be applied toward either the previous or upcoming school year. In these
cases, please put the grade the hours will be applied toward.
All hours completed during the school year need to be turned in no more than 60 days following
no more than 60 days following
no more than 60 days following
no more than 60 days following the completion of the
activity. Hours completed during summer vacation must be turned in no later than September 30
no later than September 30
no later than September 30
no later than September 30
th th th th
of the following fall.
Site Information
Site Information
Site Information
Site Information
Volunteer Site _____________________________________________ Date(s) of Service _____________
Description of Activities:
_______________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
For what person or group: _________________________________________________________________
Total # Hours: _____________
Total # Hours:
Total # Hours:
Total # Hours:
Sponsor/Supervisor Signature: ____________________________________________________________
Sponsor/Supervisor Signature:
Sponsor/Supervisor Signature:
Sponsor/Supervisor Signature:
Email Address: ____________________________________________ Phone # _____________________
Reflection
Reflection
Reflection
Reflection
Attention Seniors: All community service forms must be received by the school office no later than April 30
Attention Seniors:
no later than April 30 of the senior year
of the senior year
Attention Seniors:
Attention Seniors:
no later than April 30
no later than April 30
of the senior year
of the senior year
in order to participate in the graduation ceremony.
The following must be completed in
The following must be completed in order for service hours to be accepted.
The following must be completed in
The following must be completed in
order for service hours to be accepted.
order for service hours to be accepted.
order for service hours to be accepted.
1. Describe your typical day at this agency/site. What activities did you assist with?
2. What skills or knowledge were needed to perform your service? Did you learn any news skills?
3. Describe how you feel the community benefited from your service. Did the service you performed
impact your life? How?
Student Signature _________________________________________ Date _______________________
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