Sjcsd Community Service Verification Form
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1SJCSD Community Service Verification Form
All recorded hours must meet the guidelines set forth in the SJCSD Community Service Hours
Guidelines document. Please attach documentation of hours on business letter head and your SJCSD
Community Service Proposal and Reflection sheet.
Student Name:
____________________________________________
Grade: __________
Phone number:
_____________________
Graduation Year:
__________
Community Service Performed
Hours
Start Date – End Date
_______ - _______
Description: _________________________________________________
___________
_______ - _______
Description: _________________________________________________
___________
_______ - _______
Description: _________________________________________________
___________
_______ - _______
Description: _________________________________________________
___________
_______ - _______
Description: _________________________________________________
___________
_______ - _______
Description: _________________________________________________
___________
_______ - _______
Description: _________________________________________________
___________
Total Hours
___________
Hours approved by: ______________________________________________________
___________
Counselor’s or Designee’s Signature
Date
Verification forms should be turned into the Guidance Office at the end of each school year for
students in grades 9 – 11 and at the end of each semester for seniors.
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