Community Service Verification Form
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1
2NO
grades can be given for
service; neither lowered,
COMMUNITY SERVICE VERIFICATION FORM
raised, or as extra credit.
All Community Service Must Be Unpaid and Volunteer Work
NO
For details please refer to SUHSD Community Service Guidelines
pay may be received for
service.
Student Name: __________________________________________________ ID #: __________________
NO
family members may be the
School Name:_____________________________ Social Science Teacher:_________________________
recipients or supervisors of
service.
1. To be completed BEFORE performance of the community service activity:
NO
Description of Community Service:
credit will be given for
service during student’s
regular school hours.
Name of Organization: __________________________________________________________________
NO
__________________________________________
Describe the Community Service Activity:
credit will be given for
extracurricular (co-
_______________________________________________________________________
curricular) activities or
student aide activities.
_______________________________________________________________________
NO
credit for service will be
Parent/Guardian Permission: I, parent/guardian of the above-named student, give my permission
recorded without a parent
for my son/daughter to participate in the community service activity described below.
or guardian’s
signature.
NO
Parent/Guardian Signature: ____________________________________________Date:_______________
credit will be given for
work with a profit-making
Social Science Teacher Pre-Approval. If you complete hours without teacher pre-approval, you take the
organization.
risk that your teacher may not accept your service hours as valid.
NO
Social Science Teacher Signature: __________________________________________Date:___________
credit will be given for
court-required or other
punitive service.
2. To be completed DURING performance of the community service activity:
Date
Time From ___to ___
# of Hours
Supervisor Signature
Position
Phone #
Total Number of Hours: ___________
For additional hours use Verification Log –Attachment A.
Sweetwater Union High School District programs and activities shall be free from discrimination based on gender, sex, race, color, religion,
ancestry, national origin, ethnic group identification, marital or parental status, physical or mental disability, sexual orientation or the
perception of one or more of such characteristics.
.
SUHSD Board Policy 0410
Revised Form - May 2013.
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