Community Service Verification Form Page 2
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1
2
3grades can be
6. Date: _______Time: _______ # of Hours: ______
given for service,
neither lowered,
Organization: __________________________________________________________
raised, nor extra
credit, except by
Supervisor’s Signature & Position: ________________________________________
WWoW leaders
for routine
Phone Number or Email Address: _________________________________________
verification of
quarterly service.
7. Date: _______Time: _______ # of Hours: ______
NO
pay may be
Organization: __________________________________________________________
received for
Supervisor’s Signature & Position: ________________________________________
service.
Phone Number or Email Address: _________________________________________
NO
credit will be
given for service
8. Date: _______Time: _______ # of Hours: ______
during a student’s
Organization: __________________________________________________________
regular school
hours.
Supervisor’s Signature & Position: ________________________________________
NO
Phone Number or Email Address: _________________________________________
credit will be
given for
extracurricular
9. Date: _______Time: _______ # of Hours: ______
activities or for
Organization: __________________________________________________________
student aide
activities.
Supervisor’s Signature & Position: ________________________________________
NO
Phone Number or Email Address: _________________________________________
credit will be
given for
community
10. Date: _______Time: _______ # of Hours: ______
service
conducted for
Organization: __________________________________________________________
activities related
Supervisor’s Signature & Position: ________________________________________
to the ICS
communityie….c
Phone Number or Email Address: _________________________________________
arnival, sports
programs, ECAs,
etc.
Examples of possible community service activities:
Assisting at Boy or Girl Scouts
Tutoring primary school students
Helping at a nonprofit organization like the Salvation Army
Willing Hearts or Families in Transition
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